bluuebunny/crossref_metadata_2025 huggingface dataset:
1536Antimicrobial resistance in the emerging COVID-19 pandemic
Authors: Jaiswal Abhishek , Jaiswal Ankita , Puri Surabhi , Pal Adarsh
Published: September 2021

Background

Inappropriate usage of antibiotics among COVID-19 patients can raise disastrous effects on antimicrobial resistance management and antibiotic stewardship programs. A study from USA reported 71% of COVID-19 patients received antibiotics while only 4% had bacterial co-infection. Similar findings were reported from a review of data from COVID-19 cases in Asia, which reported more than 70% of the patient receiving antibiotics however less than 10% on average had bacterial coinfection. The World Health Organisation discourages the use of antibiotics for mild cases of COVID-19, however they recommend it for severe cases at increased risk of secondary bacterial infection and death. This review aims to discuss the usage of antibiotics in COVID-19 patients pointing the role of bacterial coinfections, types of antibiotics used, and antibiotic resistance.

Methods

We systematically searched Medline, Cochrane library, Google Scholar for eligible studies published from 1st January 2020 till 29th May 2021. We included English language articles. We included patients of all age groups, in all settings. Primary outcome variable was bacterial coinfection and antimicrobial usage among COVID-19 patients.

Results

Less than 10% of the hospitalised COVID-19 patients had bacterial Co-infection. Antibiotics used among COVID-19 positives were moxifloxacin, ceftriaxone, azithromycin, piperacillin-tazobactam, levofloxacin, meropenem, etc.

Conclusions

Low proportion of COVID-19 patients had bacterial co-infection. Routine usage of antibiotics among COVID-19 positives should be discouraged.

Key messages

Bacterial co-infection among COVID-19 patients is low and therefore misuse of antibiotics among them should be discouraged.
1537Fighting against the pandemic or threatening the environment? Unforeseen challenges during COVID-19 pandemic
Authors: Jaiswal Abhishek , Shukla Nidhi , Singh Shashi Shekhar , Shrivastava Richa , Santra Archismita , Jaiswal Ankita , Salve Harshal
Published: September 2021

Background

In the current scenario of COVID-19 outbreak whereby the virus spreads through fomites and aerosols, there has been a huge increase in the use of soaps, sanitizers and personal protective equipment’s (PPEs) which in turn is causing huge amount of liquid and solid waste generation. We briefly describe here as how this pandemic is causing an impact on global environment. We also provide a rationale of using a modelled treatment framework using a reverse logistic network as temporary waste management measure during this pandemic.

Methods

We systematically searched Medline, Cochrane library, Google Scholar, Embase for articles published in English language describing the increased Biomedical waste generation in the current COVID-19 pandemic.

Results

As of July 2020, the volume of the COVID biomedical waste generated across India was 101 metric tons per day where Maharashtra was the largest producer of biomedical waste with about 17.5 metric tons per day.

Conclusions

Rationale use of personal protective equipment according to the exposure level of the biological hazard should be ensured by health workers and communities. Awareness regarding the proper disposal of the personal protective equipment and other biomedical wastes generated should be created. Also, proper segregation of biomedical wastes from the point of generation to the point of disposal and treatment should be done.

Key messages

Inappropriate usage and disposal of PPEs in the current COVID-19 pandemic is a huge hazard to the environment.
475Machine learning approach: identifying the impact of heatwaves and air quality on children’s health
Authors: Patel Dimpalben , Jian Le , Xiao JianGuo , Jansz Janis , Yun Grace , Lin Ting , Pereira Gavin , Robertson Andrew
Published: September 2021

Background

Heatwaves, air pollution and their effects on children’s health can vary temporally and spatially. With the emergence of advanced methods such as machine learning, there is an opportunity to improve prediction of children’s health events associated with those exposures.

Methods

Daily records on emergency department attendances (EDA) for children <15 years, heatwaves, landscape fire burns and air pollutants (CO, SO2, NO2, O3, PM10, PM2.5) were collected for Western Australia, 2006-2015. Decision tree, random forest (RF) and geographical RF (GRF) were compared to predict EDA, identify important risk factors and locations at elevated risk. Validation was performed by comparing actual and predicted EDA.

Results

RF was the best model with the lowest root mean squared error (MSE). The best RF validation model had an r-squared (R2) =0.95. The percentage increase in MSE indicated that PM10 and PM2.5 were important predictors of EDA for all children. Number of burns was more important in 5-9 year age group than other groups. GRF models (R2 0.90-0.98) showed that heatwave and PM2.5 were the important predictors in southern part of the study area for all age groups.

Conclusions

The importance of risk factors to predict EDA was varied by age groups and locations. Such differences are important when developing targeted health promotion strategies tailored to age groups and geographical locations.

Key messages

RF predicted EDA better than other models. Evaluation of spatial variation of heatwave and air quality effects on EDA for children by GRF modelling is useful to identify at risk geographical locations.
424Person-centred outcomes among 22,205 cancer survivors and 244,000 people without cancer: a population-based Australian study
Authors: Joshy Grace , Thandrayen Joanne , Koczwara Bogda , Butow Phyllis , Laidsaar-Powell Rebekah , Rankin Nicole , Canfell Karen , Stubbs John , Grogan Paul , Banks Emily
Published: September 2021

Background

With the majority of people with cancer surviving long-term, holistic consideration of health and wellbeing outcomes is critical to optimise survivorship. We quantified short- and long-term physical and mental health-related outcomes in people with and without cancer, including according to cancer type and clinical characteristics.

Methods

45 and Up Study (n = 267,153) baseline survey data (2006-2009) were linked to cancer registrations (by the Centre for Health Record Linkage) and cancer diagnoses up to enrolment identified. Modified Poisson regression estimated age-and-sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes - severe physical functioning limitations, moderate/high psychological distress and fair/poor quality of life - in participants with versus without cancer.

Results

Cancer survivors (n = 22,205) had significantly higher prevalence of physical functioning limitations compared to participants without cancer (21% versus 13%) PR = 1.28(95%CI=1.25-1.32), overall and in all population subgroups examined. Corresponding estimates were 22% versus 24% (1.05(1.02-1.08)) for psychological distress and 15% versus 10% (1.28(1.24-1.32) for fair/poor quality of life. Outcomes varied by cancer type, being worse for multiple myeloma, lung cancer and non-Hodgkin’s lymphoma; worse outcomes were also associated with recent diagnosis, recent treatment and advanced stage. Physical functioning limitations in cancer survivors were major contributors to adverse distress and quality of life outcomes.

Conclusions

Cancer survivors experience adverse physical and mental health outcomes; substantial parts of elevated distress and poor quality of life are likely attributable to physical disability.

Key messages

In addition to routine screening for psychological distress, management of physical disability and other symptoms are important to optimise cancer survivorship.
892Quantification of mortality incorporating multiple causes of death: Application of weighting strategies to Australian data
Authors: Joshy Grace , Bishop Karen , Balogun Saliu , Moreno-Betancur Margarita , Eynstone-Hinkins James , Moran Lauren , Korda Rosemary , Rao Chalapati , Banks Emily
Published: September 2021

Background

Mortality statistics are typically based on a single underlying cause of death (UCoD). Although UCoD provides a useful construct, the relevance of assuming that a single disease caused the death is diminishing, especially with increased life expectancy and high proportions of deaths in older ages from chronic/degenerative diseases. Focussing on common underlying causes of death in Australia, we quantified mortality incorporating weighting strategies for multiple causes of death (MCoD).

Methods

All deaths registered in Australia from 2015-2017 (478,396 deaths) and coded using International Classification of Diseases Version 10 were classified using an extended cause list (n = 136 causes) based on a World Health Organization short list. Age-standardised rates (ASR) were estimated using three weighting methods: (1) traditional approach using UCoD alone; (2) UCoD and associated causes of death (ACoDs) equally weighted and (3) UCoD weighted 0.5 arbitrarily and remaining 0.5 apportioned to the remaining ACoDs.

Results

Common UCoD were ischaemic heart diseases, cerebrovascular diseases, dementia; 57671, 31515 and 27377 deaths respectively. There were substantial changes in ASR depending on the weighting method used. Variation in mortality patterns estimated using the three weighting methods and challenges to further refinement of the weighting strategy will be discussed.

Conclusions

Mortality indicators incorporating MCoD enhance traditional measures of mortality and provide a means to reassess the role of diseases in causing death. Further disease specific methods are required to refine current weighting strategies.

Key messages

Weighting strategies for are useful for quantifying mortality incorporating MCoD, but methodological challenges exist.
659‘Ikigai’, subjective well-being and participation in community support activities among the elderly in Japan
Authors: Kamei Midori , Motohashi Chiemi , Inoue Naoko , Nishina Motoko , Ohta Akiko , Miyazaki Takashi , Takahashi Mihoko , Uemura Makiko
Published: September 2021

The Abstract Template is flexible to accommodate Empirical Results or Narrative style submission types. First, determine whether your presentation content fits within the Empirical Results style or Narrative style. Next, remove the section from the below template that does not fit your submission type and complete the appropriate section of the template accordingly. Please ensure that you follow the below format and instructions for your submission.

Background

Text: ‘Ikigai’, subjective well-being which is the Japanese concept to a good life plays important role for a long and active aging. We examined the cross-sectional association between ‘Ikigai’ and participation in community support activities in the elderly aged 65-74 for building community social capital in the current active aging policy of Japan.

Methods

Text: The target population was all residents aged 65-74 years without disabilities in a municipality, Japan. The self-administered questionnaires were mailed to 5,163 individuals in 2018. A Total of 2,283 persons responded (response rate, 44.2%). Participants provided information on basic characteristics, ‘Ikigai’, perceived health, and intention to participate in community support activities for the elderly, the children care, and the disabled.

Results

Text: A total of 1,089 (47.7%) persons showed positive intention to participate in community support activities for the elderly. Respondents who had ‘Ikigai’ were 1,796 (78.7%). Respondents who had ‘Ikigai’ were more likely to participate in community support activities for the elderly than those who did not. The same trends were shown in community support activities for the children care or the disabled.

Conclusions

Text: Elderly people who had ‘Ikigai’ were more likely to participate in community support activities. ‘Ikigai’ may have an important role for making mutual ties and good life for active aging in the community.

Key messages

Text: ‘Ikigai’ may have an important role for active aging in the community.
1312Population-attributable fraction estimates for factors of different types of anaemia among women: multilevel multinomial analysis
Authors: KIBRET Kelemu Tilahun , Chojenta Catherine , Loxton Deborah , D'Arcy Ellie
Published: September 2021

Background

Anaemia is one indicator of poor health in women and responsible for substantial mortality. Assessing the relative impact of predictors for anaemia among women could help to prioritize targeted preventions strategies. This study aimed to quantify the attributable burden of modifiable factors for different severity levels of anaemia among Ethiopian women.

Methods

Adjusted odds ratio and exposure prevalence for selected factors were used to calculate population attributable fractions using the 2016 Ethiopian Demographic and Health Surveys data. Adjusted odds ratios (AOR) with 95% confidence intervals (CIs) were computed using multilevel multinomial regression models.

Results

In Ethiopia, an estimated 14.6% (95% confidence interval, CI: 3.4, 24.5) of mild anaemia was attributable to no formal education, 11.2% (95%CI: 1.2, 19.9) to high gravidity (≥ 4) and 5.2% (95%CI: 0, 10.7) to currently breastfeeding. Similarly, proportion of moderate-severe anaemia attributable to rural residence was 38.1% (95%CI: 15.9, 54.8), poorest wealth quantile was 12.6% (95%CI: 2.9, 24.6), previous five years birth was 10.5% (95%CI: 2.9, 18.2), and unimproved latrine was 17% (95% CI: 0, 32.5).

Conclusions

The result suggests that low education, low wealth status, high parity, rural residency, pregnancy and breastfeeding contribute substantially to the occurrence of anaemia among women.

Key messages

Mild anaemia could be reduced by setting intervention strategies targeting women with low education, multigravida women, and breastfeeding women, while preventing moderate-to-severe anaemia may require increasing income, and improving living environments like hygienic latrines.
562The “quiet revolution” and mental health? Associations between household-employment configurations and mental-health across 17 years
Authors: King Tania , Taouk Yamna , LaMontagne Tony , Maheen Doctor Humaira , Kavanagh Anne
Published: September 2021

Background

Despite evidence that employed women report more time pressure and work-life penalties than employed men and other women, scant attention has been paid to the possible health effects of female labour-force participation.

Methods

This analysis examined associations between household labour-force arrangements and the mental health of men and women using 17 waves of data from the Household Income and Labour Dynamics Survey. Mental health was measured using the Mental Health Inventory (MHI-5). A five-category measure of household employment configuration was derived: dual full-time employed, male-breadwinner, female-breadwinner, shared part-time employment (both part-time) and male full-time/female part-time (1.5-earner). Using fixed effects regression methods, we examined the within-person effects of household employment configuration on mental health, controlling for time-varying confounders.

Results

For men, being in the female-breadwinner configuration was associated with poorer mental health compared to being in the 1.5-earner configuration (b-1.98, 95%CI -3.36, -0.61). The mental health of women was poorer when in the male-breadwinner configuration, compared to when in the 1.5-earner arrangement (b-0.89, 95%CI -1.56, -0.22).

Conclusions

The mental health of both men and women is poorer when not in the labour-force, either as a man in the female-breadwinner arrangement, or as a woman in the male-breadwinner arrangement.

Key messages

These results suggest that the mental health of women and men benefits from labour-force participation. The results are noteworthy for women, because they pertain to a sizeable proportion of the population who are not in paid employment, and highlight the need for policy reform to support women’s labour-force participation.
1424Knowledge, Attitudes, and Practices towards COVID-19: An Epidemiological Survey in Mumbai, India
Authors: Kotian Sneha Pratap , Waingankar Prasad , Tawde Ashlesha
Published: September 2021

Background

The COVID-19 pandemic has become a serious public health concern around the world, with countries taking significant preventive and control measures to halt the spread of this deadly virus. The knowledge, attitude & practices (KAP) of the general population play a major role in the containment measures adopted by the country. The current study was conducted to assess the KAP of the population of Mumbai towards COVID-19 pandemic.

Methods

The study was a web-based, cross sectional survey. A Snowball sampling technique was used. The digital forms were made available in local languages. A 25-item survey instrument was developed according to the guidelines issued by the Government to test the KAP of the population about COVID-19. Cronbach’s alpha was used to measure the internal consistency of the questionnaire. Chi-square test or Fischer exact test was used to compare categorical data and multiple linear regression was used to identify factors influencing KAP.

Results

A total of 1360 responses were included in the study. The overall knowledge, attitude and practice score was 83.7%, 77.33% and 63.8% respectively. About 14.85% did not know about the asymptomatic spread of COVID-19.

Conclusion

The assessment of COVID-19 related KAP among the public could be instrumental in providing better insights to the policy makers to deliver tailored health intervention programmes.

Key messages

The findings of this study can serve as a guide to future efforts aimed at public readiness to adhere to control measures to address such emergency crises.
238Social gradient of self-rated health in elderly – the moderating/mediating role of sense of community
Authors: Lai Eric TC , Yu Ruby , Woo Jean
Published: September 2021

Background

Social gradients of self-rated health (SRH) of elderly are evident in various settings. However, it is not clear whether improving elderly’s sense of community (SoC) could mitigate the social gradient.

Methods

Elderly aged 60+ in 5 residential districts of Hong Kong were sampled using multi-stage sampling (n = 1793). SoC was measured using the validated 8-item Brief Sense of Community Scale, with each item on a 5-point Likert scale, forming a score from 8 to 40. SRH was considered as a continuous score from 1 (poor) to 5 (excellent). Socioeconomic status (SES) was operationalized as monthly income, highest education attainment and self-rated disposable income (defined as whether the elderly feels he/she has sufficient income). Causal mediation analysis was used to assess whether SoC mediates/moderates the association of SES and self-rated health.

Results

A social gradient of SRH by all measures of SES was observed [b per SD income increase=0.11; 95% confidence interval (95%CI) 0.07 to 0.16; b comparing lowest to highest education=-0.63; 95%CI -0.84 to -0.43; b comparing very sufficient to very insufficient disposable income=-0.76; 95%CI -0.97 to -0.56]. Causal mediation analysis showed that SoC interacts with the association of education and SRH, with higher the SoC stronger the education gradient. SoC mediates the relationship between disposable income and SRH [pure indirect effect=-0.12 (95%CI -0.20 to -0.03).

Conclusions

SoC interacts/mediates the associations of education/disposable income and SRH by accentuating them.

Key messages

Our findings suggested that improving SoC could not lead to mitigating of social gradient of SRH in the elderly population in Hong Kong.
98Framework for the Treatment And Reporting of Missing data in Observational Studies: The TARMOS framework
Authors: Lee Katherine , Tilling Kate , Cornish Rosie , Carpenter James
Published: September 2021

Focus of presentation

Missing data are ubiquitous in medical research. Although there is increasing guidance on how to handle missing data, practice is changing slowly and misapprehensions abound, particularly in observational research. We present a practical framework for handling and reporting the analysis of incomplete data in observational studies, which we illustrate using a case study from the Avon Longitudinal Study of Parents and Children.

Findings

The framework consists of three steps: 1) Develop an analysis plan specifying the analysis model and how missing data are going to be addressed. Important considerations are whether a complete records analysis is likely to be valid, whether multiple imputation or an alternative approach is likely to offer benefits, and whether a sensitivity analysis regarding the missingness mechanism is required. 2) Explore the data, checking the methods outlined in the analysis plan are appropriate, and conduct the pre-planned analysis. 3) Report the results, including a description of the missing data, details on how missing data were addressed, and the results from all analyses, interpreted in light of the missing data and clinical relevance.

Conclusions/Implications

This framework encourages researchers to think carefully about their missing data and be transparent about the potential effect on the study results. This will increase confidence in the reliability and reproducibility of results from published papers.

Key messages

Researchers need to develop a plan for missing data prior to conducting their analysis, and be transparent about how they handled the missing data and its potential effect when reporting their results.
1275Lifetime cancer risks from occupational radiation exposure among workers at interventional radiology departments
Authors: Lee Won Jin , Bang Ye Jin , Kim Young Min , Cho Sung Bum
Published: September 2021

Background

Interventional medical radiation workers represent an under-studied population worldwide, although they receive relatively high occupational radiation doses. This study aimed to estimate the lifetime cancer risk from occupational radiation exposure among workers at interventional radiology departments.

Methods

A field survey of interventional medical workers in nationwide branches of the Korean Society of Interventional Radiology was conducted in 2017. Organ-specific radiation doses were estimated using national dose registry data and conversion coefficients provided by the International Commission on Radiological Protection. Lifetime attributable risk (LAR) and lifetime fractional risk (LFR) were calculated based on realistic exposure scenarios using a radiation risk assessment tool.

Results

LARs from occupational radiation exposure until the age of retirement for all cancers combined were 338 (90.3-796.1), 121 (33.5-288.7), and 156 (41.1-390.6) per 100,000 individuals for male radiologists, male radiologic technologists, and female nurses, respectively. LFR for all cancers combined ranged from 0.22% (0.06-0.53) to 0.63% (0.17-1.47). Regarding the organ site, the highest LAR and LFR among all groups were observed for thyroid cancer.

Conclusions

This study provides timely evidence of potential cancer burden from the current levels of occupational radiation exposure among workers at interventional radiology departments. The risks varied by occupational groups, and workers, particularly interventional radiologists, need to be carefully monitored for radiation.

Key messages

We projected lifetime cancer risks from occupational radiation exposure among workers at interventional radiology departments in South Korea. Particularly, interventional radiologists, should be prioritized for careful protection from the potential health risks of occupational radiation exposure.
1366Environmental noise exposure and mental health: an analysis of a longitudinal survey of Australian households
Authors: Li Ang , Mansour Adelle , Martino Erika , Bentley Rebecca
Published: September 2021

Background

Persistent exposure to environmental noise in people’s homes has been associated with cardiovascular disease and poor mental health. Many studies conducted on noise and health are based on observational studies and the extent to which findings reflect residual confounding are not known.

Methods

Using the Household, Income and Labour Dynamics survey in Australia, we examine the impact of environmental noise (traffic, airplanes, train, industry) on self-reported mental health measured by the Short Form 36 Health Survey. Fixed-effects longitudinal regression analyses are used to account for differences between people over time, reducing confounding from time-invariant factors and reporting bias. Time-varying factors were adjusted including age, education, equivalised income, employment, household structure, chronic condition, government payment status and tenure type.

Results

Results show a significant decrease in average mental health as the level of noise increased. Exposure to loud traffic noise ‘fairly commonly’ or ‘very commonly’ negatively impacted mental health (-1.18; 95%CI -1.56, -0.81 and -1.33; 95%CI -1.77, -0.89) and exposure to noise from airplanes, trains or industry ‘fairly commonly’ or ‘very commonly’ negatively impacted mental health (-1.57; 95%CI -1.88, -1.27 and -1.48; 95%CI -1.89, -1.08).

Conclusions

This provides robust evidence of short-run mental health effects of noise exposure within people’s homes. More research could be done to explore this over a longer-time frame.

Key messages

With increasing numbers of people living in urban areas, reducing environmental noise near people’s homes or improving the capacity of homes to reduce external sources of noise (e.g. double glazing) may have public health benefit.
548Cancer treatment and survival disparity in South Australia women with invasive breast cancer during 2000-2014
Authors: Li Ming , Roder David
Published: September 2021

Background

Survival improvement from breast cancer has been attributed mostly to treatment advances and earlier cancer detection. This study was to investigate cancer treatment and the association with survival.

Methods

A total of 13494 female patients with invasive breast cancer recorded on the South Australia Cancer Registry in 2000-2014 were included. Cancer treatments within 12 month following diagnosis were identified from linked cancer registry and other medical registries. Study factors included demo sociographic, tumour profile and comorbidity. Adjusted odds ratios and sub hazard ratios were reported on treatment and survival disparity respectively.

Results

98% patients were treated with one or more treatment types. 56% had conserving surgery. Systemic treatment was received by 72%. Older patients with advanced cancer were less likely to have any treatment. Women in the most socioeconomically advantaged area were less likely to have combined mastectomy and conservative surgery (aOR 0.73, 95% CI 0.54-0.98), but more likely to have systemic treatment (aOR 1.44, 95% CI 1.26-1.64). Other factors such as country of birth, residential socioeconomic status, cancer differentiation, and diagnosis period differed in their associations with treatment type. Having conserving surgery predicted the lowest breast cancer death (adjusted SHR 0.31, 95% CI 0.26-0.36) compared to no surgery.

Conclusions

Breast cancer patients underwent varied treatment types with different impact on breast cancer mortality.

Key messages

Patients undergoing conserving surgery were at the lowest risk of the cancer death.
594ICE FALCON: a method more powerful than Mendelian Randomisation for causation assessment
Authors: Li Wenyan , Lu Ciyong
Published: September 2021

Background

Evidence shows that sexual minority adolescents (SMA) have a higher risk of developing emotional and behavioral problems (i.e., internalizing and externalizing problems) than their heterosexual peers, which may subsequently cause an increased risk of suicidality. However, the associations remain unclear and whether biological sex may moderate such associations is still unknown. The current study was conducted among Chinese adolescents to test whether emotional and behavioral problems mediates association between sexual minority status and suicidal behavior and to explore whether such mediation is moderated by biological sex.

Methods

Data were drawn from 7th to 12th grade students of the 2019 School-based Chinese Adolescents Health Survey (n = 16,663). Self-reported questionnaires were adopted and moderated mediation models were performed.

Results

Emotional and behavioral problems (peer, emotional, conduct problems and hyperactivity) partially mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.017, 95% CI = 0.012–0.022) and suicide attempts (indirect effect = 0.010, 95% CI = 0.007–0.014). Greater effects were found among female students than males who self-identified as sexual minorities, suggesting these indirect effects were moderated by biological sex.

Conclusions

Biological sex moderates the indirect effects of emotional and behavioral problems on association between sexual minority status and suicidal behaviors. Early school-based suicide prevention strategies can be targeted at SMA (particularly female students who suffer from emotional or behavioral problems).

Key messages

Emotional and behavioral problems are associated with an elevated risk of suicidality among SMA. Biological sex moderates these associations.
476Associations between prenatal perfluoroalkyl substance exposure and cord thyroid hormones using BKMR model
Authors: Liang Hong
Published: September 2021

Background

Perfluoroalkyl substances (PFASs) are a class of synthetic compounds widely detected in humans. We aimed to examine associations between prenatal PFAS exposure and cord thyroid hormones levels.

Methods

We studied 300 mother-infant pairs in Shanghai-Minhang Birth Cohort Study. We measured eight PFASs in maternal plasma samples collected at 12-16 gestational weeks, and total thyroxine (T4), free T4 (FT4), total triiodothyronine (T3), free T3 (FT3), and thyroid stimulating hormone (TSH) in cord plasma. Bayesian kernel machine regression (BKMR) model was used addressing high correlations between PFAS mixture.

Results

Maternal PFAS mixture was positively associated with cord T3/FT3 concentrations, such that the 75th percentile of PFAS mixture was associated with 0.074 (95%CI: 0.037, 0.146) nmol/l increase in T3 and 0.095 (95%CI: -0.005, 0.195) pmol/l increase in FT3, compared with the 25th percentile. Regarding single-exposure effect, PFOA at 75th percentile was associated with increased T3 (0.0396 nmol/l, 95%CI: 0.007, 0.072), FT3 (0.159 pmol/l, 95%CI: 0.055, 0.264) and TSH (1.50 uIU/ml, 95%CI: 0.379, 2.621), while PFNA was associated with decreased FT3 (-0.148 pmol/l, 95%CI -0.271, -0.0253) and TSH (-1.621 uIU/ml, 95%CI: -2.959, -0.2835). PFDA was associated with increased FT3 (0.112 pmol/l, 95%CI: -0.0311, 0.2559).

Conclusions

Prenatal FPAS exposure was positively associated with T3/FT3 with predominant compounds of PFOA, PFNA, and PFDA.

Key messages

Using BKMR addressing highly correlated PFASs, prenatal exposure to eight PFASs was associated with increased cord T3/FT3 levels with PFOA, PFNA, and PFDA being predominant compounds.
1445Antibiotic susceptibility of Helicobacter pylori in Arctic Canadian Indigenous communities
Authors: Lindsey Lauren , Quilty Doug , Cromarty Taylor , Assi Ali , Zanten Sander Veldhuyzen van , Goodman Karen
Published: September 2021

Background

Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. A key concern is poor effectiveness of anti-Hp treatment. We aimed to describe antibiotic resistance patterns in Hp isolated from project participants.

Methods

Participants in 7 communities underwent upper gastrointestinal endoscopy with 2 gastric biopsies taken for tissue culture during 2008-2017. We tested Hp isolates for resistance to 7 antibiotics by Etest and assessed 4 outcomes: resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics. We tabulated proportion positive among isolates tested with 95% confidence intervals (CI) and used logistic regression to assess the relation of age and sex to resistance outcomes.

Results

Of 259 Hp isolates tested, resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics were (% [CI]): respectively, 35 [29-41], 19 [15-25], 44 [38-50], and 12 [8-17] overall; 38 [30-47], 24 [17-32], 49 [41-58], and 16 [11-23] in 146 isolates from women; and 30 [22-39], 13 [8-21], 36 [27-46], and 6 [3-12] in 113 isolates from men. Odds of resistance to clarithromycin, 1+ antibiotics, 2+ antibiotics, and, to a lesser degree metronidazole, were elevated in women relative to men after age adjustment and increased with age in women but not men.

Conclusion

In Arctic Indigenous communities in Canada, women were more likely than men to harbor antibiotic-resistant Hp, and their frequency of resistant Hp infection increased with age.

Key messages

Community-driven research answers questions posed by those who bear the disease burden.
286Collider-stratification bias when estimating variable importance using Random Forests
Authors: Long Stephanie , Lefebvre Genevieve , Schuster Tibor
Published: September 2021

Background

Advances in causal inference have helped explain the longstanding birthweight and obesity paradoxes: selection bias due to conditioning on a collider variable i.e. collider-stratification bias (CSB). The lessons learned have critical implications for the interpretation of machine learning (ML), including decision trees and random forests (RFs), that implicitly condition on input variables. RFs are a popular approach for identifying important “predictors” from large data through variable importance, defined by the average decrease in prediction accuracy. While CSB has become a recognized concern when estimating exposure-outcome effects, knowledge of its impact on ML’s variable importance measures (VIMs) is limited. Applying the causal inference framework, we investigated the accuracy of RFs’ VIMs in data-mechanisms prone to CSB.

Methods

A Monte Carlo simulation study was conducted, with binary outcome and collider variables generated from logistic models. Two exposure variables stochastically determined the outcome and a collider variable, independent of the outcome. VIMs from RFs were compared to the known causal relevance of the input variables on the outcome.

Results

While variable importance of true exposure variables was not systematically affected by CSB, validity of VIMs can be affected, leading to erroneous selection of collider variables, causally independent of the outcome, as outcome predictors.

Conclusions

In presence of CSB, VIMs are not valid measures of the causal relevance of variables and may mislead selection of truly important factors that affect the outcome.

Key messages

ML must consider causal data-generating mechanisms otherwise it may lead to erroneous assessment of variable importance regarding outcome prediction.
1018Long-term risk of distant metastasis and post-metastasis survival for breast cancer: health record linkage study
Authors: Lord Sarah , Daniels Benjamin , Kiely Belinda , O'Connell Dianne , Pearson Sallie-Anne , Beith Jane , Bulsara Max , Houssami Nehmat
Published: September 2021

Background

After early breast cancer (BC) treatment, women need information about long-term prognosis. In this population-based health record linkage study, we assessed the cumulative incidence of distant metastasis (DM) conditional on the DM-free interval; and BC-specific survival post-metastasis.

Methods

We included all women diagnosed with non-metastatic BC in the NSW Cancer Registry, 2001-2002. We used linked records from hospitals, dispensed medicines, radiotherapy services and death registrations and applied stringent criteria to determine time to first DM and BC death.

Results

6338 women were included (BC: localised 3885, regional 2453). The 5-year cumulative incidence of DM was 7.4% (95% confidence interval 6.6-8.3) for localised BC; 22.8% (21.2-24.5) for regional BC. For women DM-free at 5 years, it was 5.7% (5.0-6.6); and 11.4% (10.0-13.0) to year 10, respectively.

The annual hazard for BC death following localised BC remained lower than that for non-BC causes; for regional BC, it was similar to that for non-BC causes at 8 years.

Following DM (N = 1492), BC-specific survival varied widely (median 25 months, interquartile range 6-127). The probability of surviving BC for ≥5 years was 32.0% (29.4-34.7) overall; and 47.1% (42.6-51.5) for those with a DM-free interval >5 years.

Conclusions

Women’s risk of DM improves over time since diagnosis; and post-metastasis survival is longer for women with later DM.

Key messages

Health record linkage methods can be used for conditional risk estimates to inform women who remain DM-free after early BC about their risk of DM in subsequent years; and post-metastasis survival.
1543Gains in life expectancy in the Australian population due to reductions in smoking: comparisons between interventions targeting the population versus interventions in a specific high risk group
Authors: Mannan Haider
Published: September 2021

Background

Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively.

Methods

Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014–15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011–13 Australian Health Survey.

Results

The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation.

Conclusions

Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.
1182Vaccine hesitancy among health care workers: A study amidst COVID-19 vaccine drive in India
Authors: Mathur Medha , Mathur Navgeet
Published: September 2021

Background

After the launch of COVID-19 vaccine by the government of India in 2021, the current study was conducted to assess the vaccine hesitancy among health care workers regarding COVID-19 vaccination and its safety, efficacy, rolling out strategy and undesirable effects.

Methods

This cross-sectional study, conducted on health care workers vaccinated at a tertiary care center of southern Rajasthan using a pre-designed and pre-validated questionnaire to collect data through the ‘Exit Interview’ technique after consent and ethical approval.

Results

Out of 3102, 56.8% were male and 43.2% were female health care workers. Out of total 80.7% and 73.2% of study participants perceived the vaccine as safe and effective respectively. The vaccine hesitancy was contributed due to apprehension for undesirable effects following immunization (19.3%). The commonest undesirable effect was pain at the injection site. The perception regarding the timing of rolling out of vaccine and readiness for COVID appropriate behavior after vaccination was significant (p < 0.001). The mean time spent at vaccination site was 33.90 (±11.34) minutes ranging 5-120 minutes (median = 35; interquartile range (IQR) = 10; 95% confidence interval (CI) = 33.50-34.30).

Conclusions

The study concludes that the apprehension of undesirable effects contributed to vaccine hesitancy, but it was perceived safe and effective by health care workers.

Key messages

The vaccine hesitancy among general population and vaccine acceptance will be affected directly by instance shown by health care workers who presented themselves at the forefront both for battling the pandemic and accepting the vaccine.
267Cardiovascular preventive pharmacotherapy stratified by cardiovascular risk in a complete New Zealand primary prevention population
Authors: Mehta Suneela
Published: September 2021

Background

Many countries, including Aotearoa/New Zealand, have guidelines recommending cardiovascular disease (CVD) management based on predicted risk. We conducted the first study to examine CVD preventive pharmacotherapy, stratified by CVD risk, within a complete national primary prevention population.

Methods

Anonymised individual-level linkage of New Zealand administrative health and non-health data identified 2,250,201 individuals without atherosclerotic CVD, alive and aged 30-74 years on 31/03/2013. We identified individuals with ≥1 dispensing by community pharmacies of blood pressure lowering (BPL) and/or lipid lowering (LL) medications at baseline (1/10/2012-31/3/2013) and in 6-month periods between 1/04/2013-31/03/2016. Individuals were stratified by 5-year CVD risk.

Results

One quarter of individuals had ≥5% 5-year risk (current New Zealand guideline threshold for considering preventive medications) and 5% met the ≥15% risk threshold for recommended dual therapy. Baseline dual therapy varied according to 5-year risk: 1% with <5%, 15% with 5-9%, 31% with 10-14% and 47% with ≥15% risk. Among those dispensed baseline dual therapy, 83%-89% across risk strata were still treated after three years. Initiation of dual therapy during follow-up occurred among only 13% of high-risk individuals; people without diabetes and those aged ≥65 years were more likely to remain untreated. There were few differences in treatment maintenance across clinical/demographic sub-groups.

Conclusions

CVD primary preventive pharmacotherapy was strongly associated with CVD risk and, once commenced, was generally continued. However, only half of high-risk individuals received recommended dual therapy and treatment initiation was modest.

Key messages

Individually-linked administrative datasets can identify clinically-relevant quality improvement opportunities for an entire national population.
222Long-term mortality after early famine exposure: findings from the China Kadoorie Biobank
Authors: Meng Ruogu , Yu Canqing , Guo Yu , Bian Zheng , Yang Ling , Chen Yiping , Du Huaidong , Chen Junshi , Chen Zhengming , Lv Jun , Li Liming
Published: September 2021

Background

Previous studies suggested that increased risks of chronic diseases in China might be attributable to early experience of the Chinese Great Famine during last century, but the reliable evidence for adult mortality was rare. This study is to investigate the association of early famine exposure with death risks in the middle age.

Methods

A number of 94 051 participants from China Kadoorie Biobank were categorized as non-famine births (born between 10/1/1956 and 9/30/1958, and 10/1/1962 and 9/30/1964) and famine births (born between 10/1/1959 and 9/30/1961). The outcomes were total and cause specific mortality. Cox regression was used to estimate hazard ratio (HR) for famine exposure.

Results

During a median 10.2 years of follow-up, we documented 2802 total deaths in all participants. Prenatal famine exposure was only associated with the risks of ischemic heart disease (IHD) mortality in adulthood (310 deaths, HR [95% CI]: 1.34 [1.02, 1.75]), compared with non-famine births. We also observed the association of famine with total mortality (HR [95% CI]: 1.42 [1.12, 1.78]) in daily alcohol drinkers, but not in non-daily drinkers (P for interaction: 0.025).

Conclusions

This study indicated that early famine exposure was associated with an increased death risk of heart disease and such risk may be modified by adult alcohol consumption.

Key messages

Early Chinese famine experience might impact adult IHD deaths.

Coexistence of early famine experience and adult alcohol consumption was associated with higher risks of total mortality.
117A digital resource for enhancing parental health literacy during the transition to parenthood
Authors: Middleton Nicos , Kolokotroni Ourania , Christodoulides Veronica , Hadjigeorgiou Eleni , Gourounti Claire , Leinweber Julia , Gouni Olga , Lykeridou Katerina , Sarantaki Antigoni , Karanikola Maria , Nicolaou Christiana , Kouta Christiana , Bachetta Britta , Papain Shabira , Pedersen Eline , Baum Alison
Published: September 2021

Background

While the transition to parenthood is critical for mother-child health, traditional antenatal education has been questioned. Digital resources provide opportunities for reducing social disparities and enhancing health literacy, particularly important in a medicalized and decentralized birth environment with high caesarean and low breastfeed rates.

Methods

Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to assess the cross-national transferability of Baby Buddy (UK), and deliver a locally relevant resource to inform, enhance user-provider communications and support shared decision-making.

Results

Using consensus-building and priority-setting techniques, we engaged with the local health professional community and parents-to-be to assess available resources, identify gaps and priorities in an eDelphi survey (N = 275 mums, 193 professionals) and gain an in-depth understanding on information-seeking behaviours and participation in decision-making in a series of focus groups with antenatal educators (N = 20) and new mums/ mums-to-be (N = 62). New material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework.

Conclusions

The project is a “proof of concept” for exchange of innovation and a “complimentary” model of maternal healthcare delivery. Beyond a learning experience for the participants, the use of PAR provided ground for building transdisciplinary alliances.

Key messages

Other than enhancing health literacy, digital resources can support the educational role of health professionals

PAR provides a framework to engage with the community, building a sense of common purpose