bluuebunny/crossref_metadata_2025 huggingface dataset:
1321Marginal structural model of the causal role of hepatitis B vaccination in multiple sclerosis risk
Authors: Akhtar Saeed , El-Muzaini Hadeel , Alroughani Raed
Published: September 2021

Background

There are conflicting reports regarding the association between uptake of recombinant vaccine against hepatitis B virus (HBV) and risk of multiple sclerosis (MS). Most cohort or case-control studies found no significant short- or long-term increase in MS risk after immunization. Whereas others reported a significant increase in MS risk within three years of HBV vaccination. The present matched case-control study was conducted to test the hypothesis whether recombinant HBV vaccination status is causally associated with MS risk using targeted maximum likelihood estimation (TMLE) that uses data-adaptive flexible machine learning algorithms to estimate the causal parameters.

Methods

Confirmed 110 MS incident cases and age (± 5 years), gender and nationality matched (1:1) 110 community controls were enrolled. A pre-tested structured questionnaire was used to collect the data on demographics, environmental factors, comorbidities, history of vaccinations through face-to-face interviews both from cases and controls. We implemented case-control-weighted TMLE – a double robust, multistep procedure to estimate causal relative risk (RR), marginal odds ratio (OR) and population attributable fraction.

Results

This study demonstrated a non-specific protective effect of HBV vaccine against MS risk as estimated by TMLE (causal RR 0.63, 95% CI: 0.45-0.90; p = 0.004; marginal OR 0.43; 95% CI: 0.18-0.67; p = 0.006). The population attributable fraction was 20% (95% CI: 6%, 34%; p = 0.014))

Conclusions

Subject to inherent limitations of the case-control design, this study suggests a non-specific protective effect of recombinant HBV vaccination against MS risk. Future studies may contemplate to confirm these results.

Key message

Causal analysis showed a non-specific protective causal association between uptake of recombinant HBV vaccine and MS risk in the study population.
1250Grass pollen exposure and children’s asthma repeat admissions in Victoria, Australia
Authors: Batra Mehak , Newbigin Ed , Dharmage Shyamali C , Abramson Michael J , Erbas Bircan , Vicendese Don
Published: September 2021

Background

Paediatric asthma-related readmissions significantly challenge public health systems. As evidence suggests readmissions are possibly associated with ambient grass pollen levels, we sought to determine the relationship between grass pollen exposure and the risk of readmission for asthma among children in Victoria, Australia.

Methods

The Victorian Admitted Episodes Dataset 1st July 1997–30th June 2009 was used to identify primary admissions with a principal diagnosis of asthma for children aged 2-18 years. Total sample size was 48,068 admissions. Readmissions were defined as a subsequent admission within 28 days of index discharge. Multiple semi-parametric Poisson Generalized Additive Models were used to assess associations between the grass pollen season and daily grass pollen counts (lagged and cumulative) with repeat admissions, while controlling for meteorological factors and air pollutants.

Results

Readmissions totalled to 2,152 (4.47% of all admissions). Mean daily readmissions were 1.44 times higher during the grass pollen season (95%CI 1.03-2.02). Pollen season was associated with readmission only for the youngest age group (2-5), incident rate ratio 1.99 (95%CI 1.26-3.14). Daily readmission was non-linearly associated with same day pollen counts only for the 13-18-year age group. Lag 2 pollen counts were non-linearly associated with all daily readmissions for boys in gender-stratified and younger age groups (2-5, 6-12) in age-stratified analysis.

Conclusions

Grass pollen exposure was associated with higher readmission rates for paediatric asthma.

Key messages

Younger children and boys with severe or poorly controlled asthma need to be assessed for preventive therapies before the grass pollen season to reduce the repeat admissions.
577Inequalities in access to in vitro fertilisation treatment in France
Authors: Messaoud Khaoula Ben ,   Inequalities In Access To In Vitro Fertilisation Treatment In France Jean Bouyer,   Inequalities In Access To In Vitro Fertilisation Treatment In France Elise de La Rochebrochard
Published: September 2021

Background

In vitro fertilisation (IVF) treatment is one of the most expensive infertility treatments. Cost has been described as a substantial barrier to access. In France all infertility treatments, including IVF, are fully reimbursed, but are there other barriers to access?

Methods

Based on the French national health insurance database that exhaustively records reimbursed healthcare, this cohort study included all women aged 18–49 years unsuccessfully treated with ovarian induction (first-line infertility treatment) between January–August 2016. Outcome was IVF access within 24 months of starting first-line treatment. Univariate and multivariate regressions explored age, disadvantaged social status, driving time to nearest IVF centre, and deprivation index of area of residence.

Results

Over 20,000 women unsuccessfully received first-line treatment. Almost 80% did not access IVF within 24 months.

After age 34, probability of access decreased. Disadvantaged social status and living in a disadvantaged area were associated with lower probability of accessing IVF. Driving time to the nearest IVF centre was not significantly associated with access.

Conclusions

Socio-economic barriers to access IVF exist despite full treatment reimbursement in France. To reduce health inequalities, we need to better understand the nature and patterns of these barriers among less socially advantaged people.

Key messages

After failure of first-line infertility treatment, only 20% of women access IVF although it is fully reimbursed in France.

Age, but most importantly socio-economic status, is a key determinant of access to IVF treatment.

Distance from nearest IVF centre does not appear significant in explaining access to treatment in France.
984A novel cost diary approach to analyse the financial burden of living with arthritis
Authors: Berkovic Danielle , Ayton Darshini , Briggs Andrew , Ackerman Ilana
Published: September 2021

Focus of Presentation

Amongst Australia’s working-age population with arthritis, financial distress is known to be high and contribute to poorer health outcomes. Yet the personal financial burden of living with arthritis is not well understood. Here we present initial findings from one of the first projects to measure personal financial distress as a determinant of health for individuals living with arthritis.

Findings

Participants aged 18-50 years detailed their arthritis-attributable out-of-pocket costs in an online consumer-informed cost diary; once a week, for six weeks, alongside a work productivity and financial distress scale. Costs were grouped into seven categories, including: direct medical appointments, allied health appointments, other health appointments, medications or supplements, symptom/pain management items, medical tests, and other expenses. Costs per individual per week ranged from $40.30 (AUD) to $25,789 (AUD). High costs were not linked to quality of care, demonstrated by one participant spending $495.00 (AUD) on chiropractic appointments across the six weeks. High levels of financial distress were associated with reduced work productivity, but were not associated with level of weekly expenditure.

Conclusions/Implications

Adults with arthritis experience financial hardship associated with their disease. Discussion of arthritis-related financial concerns should form part of shared clinical decision-making and education, to facilitate prioritisation of care that is evidence-based and feasible.

Key messages

These findings can be used to raise awareness of key fiscal issues relevant to adults with arthritis, and to educate clinicians about the wide-ranging impacts of arthritis beyond physical symptoms.
629Influenza-like illness surveillance in Australia: comparison of general practice data with laboratory-confirmed influenza notifications
Authors: Bernardo Carla , Gonzalez David , Stocks Nigel
Published: September 2021

Background

Influenza is a respiratory infection responsible for 645,000 annual deaths worldwide. Surveillance systems provide valuable data for monitoring influenza in order to detect outbreaks and guide public health responses. This study aimed to investigate the epidemiology of influenza-like illness (ILI) using two Australian general practice databases (MedicineInsight and the Australian Sentinel Practice Research Network (ASPREN)) and compare them with laboratory-confirmed influenza from the National Notifiable Diseases Surveillance System (NNDSS).

Methods

All patients who had a consultation in MedicineInsight general practices or ASPREN and all laboratory-confirmed influenza reported by the NNDSS between 2015-2017 were included. Weekly ILI rates per 1,000 consultations (MedicineInsight/ASPREN) were compared with influenza notifications (NNDSS).

Results

Data was consistent among sources, with higher cases in 2017, among women and patients aged 20-49 years. The peak rate in MedicineInsight almost doubled in 2017 compared to 2015, while in ASPREN it was less pronounced. MedicineInsight ILI curves more closely resembled NNDSS patterns (shape, the start of the season, peaks) than ASPREN, although both were highly correlated with NNDSS (r = 0.90 to 0.97 and r = 0.88 to 0.98, respectively).

Conclusions

MedicineInsight and ASPREN provided consistent ILI results, both resembling confirmed influenza epidemic curves, suggesting the potential use of routinely collected electronic medical records (MedicineInsight) in influenza surveillance. MedicineInsight provides comprehensive medical data, such as underlying conditions, medications prescribed and vaccination status, which could be used to improve accuracy on influenza detection.

Key messages

Electronic medical records could be used to monitor ILI in combination with ASPREN for effective early detection of outbreaks.
1214Coverage of maternal and child health in slums, rural and urban areas from 42 countries
Authors: Blumenberg Cauane , Costa Janaína Calu , Barros Aluisio J.D. , Victora Cesar G
Published: September 2021

Background

Rural populations are traditionally considered to have the lowest coverage on health interventions, but little is known about urban slums. Our aim was to analyse inequalities on the composite coverage index (CCI) – a weighted average of eight interventions on reproductive health, antenatal and delivery care, immunization and management of illnesses – according to place of residence in low- and middle-income countries.

Methods

We analysed the most recent Demographic and Health Surveys (2006-2018) from 42 countries. We estimated the CCI coverage according to the classification of the clusters women and children were living in (urban non-slums; urban slums; or rural areas). Slums were defined as clusters where at least 75% of the households did not have at least two of the following characteristics: access to improved water, access to basic sanitation, solid floor material, and sufficient rooms for sleeping.

Results

The CCI coverage ranged from 24% to 86% (median 63%), being higher in urban non-slums for all 42 countries. In 14 countries, the lowest CCI coverage was found in slums. The main drivers of the lowest estimates in slums were the coverage of care seeking for pneumonia, family planning, measles and DPT immunization, which were respectively 51%, 25%, 19%, and 15% lower in slums compared to rural areas.

Conclusions

It is important that public policies are designed in order to prioritise the urban poor populations, aiming to achieve an equitable coverage of essential health interventions.

Key messages

We studied a novel inequality dimension using national standardised surveys, expanding the assessment of the health situation according to the place of residence beyond a dichotomous approach (urban/rural). Investigating maternal and child health conditions in urban slums – a group that is often marginalised in urban areas – is very important to support the design of public policies that focus on those most in need.
1152Use of Facebook to recruit cohort study participants
Authors: Bruinsma Fiona , Lynch Brigid , Southey Melissa , Giles Graham , Milne Roger
Published: September 2021

Background

Social media is a relatively new means to recruit research participants.

Methods

The Australian Breakthrough Cancer (ABC) Study is a prospective cohort study that recruited people aged 40-74 years over 2014-2018. A range of recruitment methods, including ‘traditional’ (e.g. print media, electoral roll, word of mouth) and newer methods (i.e. social media, particularly Facebook) were used. Here we describe and compare these methods of recruitment.

Results

52,614 (66%) of ABC Study registrants indicated they had heard about the study via Facebook (36,672 clicked through from an advertisement for the study and 15,942 through users ‘sharing’ content). Overall, 51,586 (64%) participants (58% female, 42% male) completed baseline study components (online questionnaires and provided a DNA sample). 58% of Facebook registrants completed baseline components, compared with 75% of those recruited by traditional methods. The cost per acquisition using Facebook was $1.66 whereas the cost per acquisition using traditional methods (e.g. via the electoral roll) was up to $30. Facebook recruitment initially attracted more female registrants but targeted advertising dramatically increased the proportion of men.

Conclusions

Targeted advertising can be used to modify the types of respondents obtained via Facebook. Although the proportion completing baseline study components was lower than for traditional methods of recruitment, the cost per acquisition was cheaper making it feasible to recruit a larger number of participants to obtain the desired study size.

Key messages

Facebook is a viable and economical source of recruits to large prospective research studies.
184Are genetic risk factors clinically useful in prognostic models for type 2 diabetes mellitus?
Authors: Buss Vera Helen , Barr Margo , Varnfield Marlien , Harris Mark
Published: September 2021

Background

Many prognostic models exist for the prediction of type 2 diabetes mellitus. Some of these include genetic risk factors. The objective of this review was to investigate whether including genetic variables in prediction models for type 2 diabetes mellitus is clinically useful.

Methods

Studies were included if they reported on prognostic prediction models for type 2 diabetes mellitus. Seven medical and bioengineering databases were searched using terms regarding risk prediction and diabetes combined via Boolean operators. In studies including genetic variables, the c-statistics of genetic and non-genetic models were compared.

Results

Seventy-six studies published between 2002 and 2019 were included in the review. Twenty of these (published 2008 to 2019) included genetic variables, namely deleterious alleles and specific small nuclear polymorphisms. Study samples represented the general population. When comparing genetic to non-genetic models, one study reported a statistically significantly greater c-statistic for the genetic and four for the non-genetic models. Adding genetic risk factors to a clinical model did not substantially increase the predictive accuracy of any study.

Conclusions

The use of genetic data did not show any meaningful improvements in the predictive performance for the general population compared to clinical models. Studies using genetic data were often based on small sample sizes and not externally validated, raising concerns regarding potential overfitting and lack of generalisability.

Key messages

Currently, the clinical usefulness of genetic risk scores for type 2 diabetes mellitus seems quite limited.
844Considering child maltreatment in social inequalities of educational achievement: a whole-of-population data linkage study
Authors: Chittleborough Catherine , Schuch Helena , Pilkington Rhiannon , Montgomerie Alicia , Grant Janet , Petersen Julie , Lynch John
Published: September 2021

Background

Strategies aimed at reducing health inequalities include a focus on improving education, a key determinant of health and labour market outcomes. Studies have demonstrated that both early life socioeconomic disadvantage and child maltreatment result in poorer educational outcomes, but have not examined the effect of the combination of these adversities.

Methods

This study used de-identified, linked government administrative data from the South Australian Early Childhood Data Project on children born in South Australia who completed Year 5 National Assessment Program—Literacy and Numeracy (NAPLAN) during 2008-2015 (n = 61,445), and their corresponding birth, perinatal, school enrolment and child protection system data.

Results

Overall, 23.7% (95% CI 23.4-24.1) had a poor NAPLAN outcome (at or below national minimum standard on three or more of the five domains - reading, writing, spelling, grammar and punctuation, numeracy). This proportion was approximately double for children who experienced substantiated maltreatment compared to children who did not experience contact with the child protection system, irrespective of the social circumstances (parental education, employment, housing and area-level disadvantage) in which the child lived.

Conclusions

Social advantage is not sufficient to protect children from poor educational outcomes if they experience substantiated maltreatment. Interventions and services will need to focus on child maltreatment, in addition to socioeconomic factors, to improve educational outcomes in the population.

Key messages

Within each social group, from advantaged to disadvantaged children, the risk of poor NAPLAN outcomes was greater for children who had contact with the child protection system.
1465Adverse cardiovascular events after cancer in Queensland, Australia
Authors: Diaz Abbey , Cunningham Joan , Lindsay Daniel , Callander Emily , Sverdlov Aaron , Shaw Joanne , Griffiths Kalinda , Garvey Gail
Published: September 2021

Background

Cancer survivors are at increased risk of cardiovascular (CV) disease, partially due to cardiotoxic anti-cancer therapies and elevated CV risk factor exposure. We describe the prevalence of adverse CV events in Queensland cancer survivors.

Methods

The Queensland Cancer Registry (QCR) identified all Queensland residents diagnosed with cancer, July 2012-June 2015. Individuals were included at their first tumour and excluded if diagnosis basis was unknown/post-mortem. The QCR, containing demographic and clinical information, was linked to Queensland Hospital Admitted Patient Data Collection records to evaluate pre-cancer CV comorbidity and post-cancer adverse CV events. All individuals had three years follow-up time.

Results

79,377 people with cancer were included. Median diagnosis age was 67 years (IQR 56-76), 44.6% were women, 5.3% had CV comorbidity and the most common cancers were prostate (19.8%), breast (17.3%), and colorectal (15.2%). 10.7% of people had an adverse CV event during follow-up; median time to first event was 362 days (IQR 124-706). Adverse CV events were most common in those aged >35 years vs ≤ 35 (11.0% vs 2%), men vs women (12.3% vs 8.7%), those with vs without CV comorbidity (29.7% vs 9.6%), and in bladder (14.7%), lung (13.1%), or colorectal (12.4%) cancer patients.

Conclusions

One in ten Queensland cancer patients are hospitalised for adverse CV events in the first three years after cancer diagnosis, associated with CV comorbidity, older age, male sex, and cancer type.

Key messages

There is urgent need for strategies to identify and deliver optimal care to cancer patients at high CV risk.
728Comparative performance of WHO-5, PHQ-9 and PSS Scale for screening antenatal depression and suicide risk
Authors: Do Phuc Huyen , Vo Van Thang , Luong-Thanh Bao-Yen , Nguyen Lan Hoang , Valdebenito Sara , Eisner Manuel , Tran Xuan Bach , Baker Philip , Dunne Michael
Published: September 2021

Background

This study evaluated the psychometric properties of three self-reported scales including WHO Well-Being Index (WHO-5), Patient Health Questionnaire-9 items (PHQ-9), and Perceived Stress Scale (PSS) for determining the severity of antenatal depression and suicide risk.

Methods

Extracted from a multi-site birth cohort study in eight countries, we test the reliability and validity of tri-scales among 148 women in the third trimester and 3-months after childbirth in Vietnam.

Results

Reliability testing achieved good internal consistency for the set of scales (Alpha = 0.75–0.81). The multitrait-multimethods matrix and SEM model indicated a good fit [Chi-square (230) = 337.5, p < 0.001; Root Mean Square Error of approximation= 0.56, Comparative Fit Index= 0.91] and good discriminant validity of WHO-5 lower discriminant validity of PSS and PHQ-9. The proportion of correctly classified cases and optimum balanced indicators of sensitivity and specificity suggested the cut-off scores of ≥ 6 for PHQ-9 and ≥ 25 for PSS for suicide risk screening. Regarding to predictive validity for postpartum depression of PHQ-9, we found that the cut-off scores of ≥ 6 for prenatal PHQ-9 screening can predict approx.70% of mild postpartum depression cases after 3-month childbirth.

Conclusions

This present study suggested adequate validity and reliability of the WHO-5, PHQ9 and PSS to measure antenatal depression and suicide risk in Vietnam.

Key messages

Further studies might consider to use one or a set of scales to understand multiple domains of mental disorder as it is simple to administer and acceptable duration for completion in the community.
870Methylation marks of prenatal exposure to maternal smoking and risk of cancer in adulthood
Authors: Dugué Pierre-antoine , Hodge Allison , Wong Ee Ming , Joo Eric , Jung Chol-Hee , Hopper John , English Dallas , Giles Graham , Milne Roger , Southey Melissa
Published: September 2021

Background

Prenatal exposure to maternal smoking is detrimental to child health but its association with risk of cancer has seldom been investigated. Maternal smoking induces widespread and long-lasting DNA methylation changes, which we study here for association with risk of cancer in adulthood.

Methods

Eight prospective case-control studies nested within the Melbourne Collaborative Cohort Study were used to assess associations between maternal-smoking-associated methylation marks in blood and risk of several cancers: breast (N = 406 cases), colorectal (N = 814), gastric (N = 166), kidney (N = 139), lung (N = 327), prostate (N = 847) and urothelial cancer (N = 404) and B-cell lymphoma (N = 426). We used conditional logistic regression models to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between cancer and five methylation scores calculated as weighted averages for 568, 19, 15, 28, and 17 CpG sites. Models were adjusted for confounders, including personal smoking history (smoking status, pack-years, age at starting and quitting), and methylation scores for personal smoking.

Results

All methylation scores for maternal smoking were strongly positively associated with risk of urothelial cancer. Risk estimates were only slightly attenuated after adjustment for smoking history, other potential confounders and methylation scores for personal smoking. Potential inverse associations were observed with risk of lung cancer and B-cell lymphoma.

Conclusions

We found that methylation marks of prenatal exposure to maternal smoking are associated with increased risk of urothelial cancer.

Key messages

Our study demonstrates the potential for using DNA methylation to investigate the impact of early-life, unmeasured exposures on later-life cancer risk.
876Association of blood markers of inflammation, vitamin status and the kynurenine pathway with age and all-cause mortality
Authors: Dugué Pierre-antoine , Hodge Allison , Ueland Per , Midttun Øivind , Ulvik Arve , Rinaldi Sabina , MacInnis Robert , Li Sherly , Meyer Klaus , Navionis Anne-Sophie , Flicker Leon , Severi Gianluca , English Dallas , Vineis Paolo , Southey Melissa , Milne Roger , Giles Graham
Published: September 2021

Background

Inflammation is a key feature of aging and a cause of numerous diseases. We investigated the association of 35 blood markers involved in inflammatory processes with age and mortality and developed a signature of ‘inflammaging’.

Methods

Thirty-five blood markers relating to the kynurenine pathway, vitamin status, and inflammation were measured in 976 participants in the Melbourne Collaborative Cohort Study at baseline (1990-1994, median age 59 years) and follow-up (2003-2007, median age 70 years). Associations of each marker with age and all-cause mortality were assessed using linear and Cox regression, respectively. A signature of inflammaging was obtained via Lasso regression of age on the markers and tested for association with mortality; we compared mortality associations for this signature and two weighted scores across all markers associated with age and mortality, respectively.

Results

Most markers (29/35) were associated with age, with strongest associations observed for cystatin C, neopterin, quinolinic acid, and the kynurenine/tryptophan ratio, PAr index, and 3-hydroxykynurenine/xanthurenic acid ratio. Many markers (14/35) showed strong associations with mortality in particular neopterin, quinolinic acid, HK/XA, PAr index, CRP, IL-6 and KTr. The inflammaging signature included six markers and showed strong association with mortality (HR = 1.5, 95%CI: 1.3-1.7), almost as strong as the association of weighted scores combining all measured markers.

Conclusions

Our study highlights the key role played by markers of the kynurenine pathway and vitamin B6 catabolism in aging, along with other well-established inflammation-related markers.

Key messages

A signature of ‘inflammaging’ based on 6 markers may be useful to better predict mortality.
466Prevalence of Dyslipidaemia Among Filipino Adults
Authors: Durante Cherry Ann
Published: September 2021

Background

An increasing trend of coronary artery disease deaths is seen in the Philippines with the main risk factors identified as hypertension and dyslipidemia. This study reviews the result of the 8th National Nutrition Survey (NNS) and determines factors associated with increasing odds of having lipid abnormalities in the Filipino population.

Methods

The 8th NNS employed a three-stage sampling design. The first stage was the selection of Primary Sampling Units (PSUs), consisting of one barangay or a combination of contiguous barangays with at least 500 households each. From these PSUs, enumeration areas (EAs) with 150-200 households were identified, from which housing units were randomly selected. The third and final stage was the random selection of the households, which was the ultimate sampling unit. Eligible members of the sampled households were included in the survey. Among the sampled households, 20,236 individuals consented to blood analysis for lipid profiling.

Results

Prevalence of lipid abnormalities was high (47%) in the sample population. Furthermore, very low HDL cholesterol (38%) and high triglycerides levels (47%) were also noted. It was found out that the odds of dyslipidemia is 1.5% higher in smokers than in non-smokers; and alcohol drinkers than non-alcohol drinkers (OR: 1.44, p < 0.0001). Also, the odds of dyslipidemia is 1.8% higher in patients with SBP>140mmHg and DBP>90mmHg (p > 0.0001). Furthermore, dyslipidemia is twice more common in Filipino women than men. It was found out that Filipinos with high physical activity is 1.2 times less likely to develop dyslipidemia

Conclusions

The increasing trend of lipid abnormalities among the Filipino population is associated with modifiable risk factors such as smoking, alcohol drinking, and sedentary lifestyle. Promoting health policies that would lead people to healthier lifestyle choices would be beneficial to the nation.

Key messages

Promoting health policies that would lead people to healthier lifestyle choices would be beneficial to the nation.
1460Is workplace bullying independently associated with musculoskeletal disorders? A study with Brazilian civil servants
Authors: Feijó Fernando , Fassa Anaclaudia
Published: September 2021

Background

Studies from high-income countries suggest that workplace bullying is associated with several occupational diseases and health outcomes, including musculoskeletal disorders (MSD). However, studies on the relationship between bullying and MSD are scarce, particularly in low- and middle-income countries. Therefore, we aimed to investigate the association between workplace bullying and MSD among civil servants from a state in southern Brazil.

Methods

Cross-sectional study with 1,615 judicial civil servants from a Brazilian state. Data was collected through a web survey. The structured questionnaire included direct questions regarding previous MSD diagnosed by a doctor. Workplace Bullying was measured by the Negative Acts Questionnaire (NAQ-r). Logistic Regression was used to estimate prevalence odds ratios (POR) and test associations of interest.

Results

The prevalence of workplace bullying was 17.7%, and the prevalence of MSD was 23.1%. After adjustment for sex and age, workplace bullying was strongly associated with MSD (POR=1.76; CI95% 1.32-2.36). In the final multivariate model, after controlling for sex, age, skin colour, body mass index, educational level, job type, ergonomic factors and physical inactivity, the association remained significant. The risk of MSD was 56.0% higher among those exposed to bullying (POR= 1.56; 95%CI: 1.14-2.13), compared to those non-exposed.

Conclusions

Findings are in line with studies from high-income countries. Bullying should be further investigated as a potential cause of MSD, and longitudinal studies are necessary to examine possible causal paths, mechanisms and mediation, especially in low- and middle-income countries. Interventions to reduce the occurrence of MSD may focus on psychosocial factor at work, particularly bullying.

Key messages

Besides being an unethical behaviour in workplaces and causing several mental health problems, bullying may also play a role on musculoskeletal disorders, what should be further investigated, particularly in low- and middle-income countries. Interventions to prevent bullying and MSD are needed.
982Injury fatalities in Australian sport: lessons from cases in the National Coronial Information System
Authors:   Edith Cowan University Lauren Fortington, McIntosh Andrew , Finch Caroline
Published: September 2021

Background

Quantifying adverse outcomes of sport participation is critical if we are to address risk and continue to promote safe physical activity. This study addresses the tip of the iceberg in sports injury - fatalities. We aimed to identify the number and trends for fatal injuries in Australian sport.

Methods

This case-series draws on data from closed cases in the Australian National Coronial Information System. A search strategy was developed to include all unintentional deaths with an external cause, where the Level One Activity code was “sport and exercise during leisure time”. Drowning and transport related cases (e.g. cycling) were excluded. Descriptive analyses are presented (number and %). The injury incidence rate (IIR) was computed for each State/Territory and a negative binomial regression model used to assess changes in deaths over time.

Results

There were 1010 unintentional injury deaths included. Most cases were males (85.2%), with the largest proportion aged 15 to 24 years (24.2%). The IIR varied from a high in 2001 at 0.49/100,000 population (95%CI: 0.34; 0.59) to a low of 0.17/100,000 people (95%CI: 0.12; 0.22) in 2014. There was a significant reduction (5% annually) in deaths from 2001 to 2015.

Conclusions

This study presents new knowledge on the scope of fatal injuries in Australian sport, providing an important benchmark for future prevention-oriented work.

Key messages

Although the rate appears to be decreasing, there is still a concerning number of fatalities from injuries sustained in sport.
1429Impact of BRCA mutation status and lifestyle factors on survival among women with ovarian cancer
Authors: Gersekowski Kate , Jordan Susan , Delahunty Rachel , Alsop Kathryn , Goode Ellen L , Bowtell David , DeFazio Anna , Friedlander Michael , Obermair Andreas , Grant Peter ,   The OPAL Study Group, Penelope Webb
Published: September 2021

Background

Despite their increased risk of developing ovarian cancer, women with an inherited BRCA1 or BRCA2 mutation have been shown to have better survival after diagnosis. Components of a healthy lifestyle, including smoking, physical activity and body mass index (BMI) have previously been associated with ovarian cancer survival; however, it is unknown whether these associations differ by BRCA mutation status.

Methods

We investigated this in 2 cohorts of Australian women with invasive epithelial ovarian cancer, using Cox proportional hazards regression models to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

In analyses of the combined studies (n = 1,741), the association between pre-diagnosis current smoking and poorer survival was stronger for BRCA-positive (HR 2.27; 95% CI 1.31-3.93) than BRCA-negative (HR 1.20; 95% CI 0.96-1.50) women (p-interaction 0.01). The associations between physical activity, BMI, alcohol intake and survival did not differ statistically significantly by BRCA status. A similar differential association with smoking was seen in a third independent cohort (n = 1,009) from the USA (HR 1.93 [0.78-4.82] vs. 1.02 [0.71-1.46]).

Conclusions

Our results suggest the association between smoking and survival may differ by BRCA status and that while smoking cessation may improve outcomes for all women diagnosed with ovarian cancer, it might provide a greater benefit among those who carry a BRCA mutation.

Key messages

The association between pre-diagnosis smoking and poorer survival after ovarian cancer diagnosis may be stronger for women who carry a BRCA mutation compared with those who don’t.
690Growth in childhood and age at menarche: Insights from individual trajectory modelling
Authors: Giles Lynne , Whitrow Melissa , Rumbold Alice , Davies Michael , Moore Vivienne
Published: September 2021

Background

The relationship between patterns of weight gain across childhood and the onset of puberty remains unclear. We aimed to derive growth parameters (size, tempo, and velocity) from models of weight across childhood and to estimate their effects on age at menarche.

Methods

Serial height and weight measurements from birth to age 9.5 years for 557 children who took part in the Generation 1 cohort study were used, along with girls’ menstrual history at age 12-13 years. Shape invariant random effects models were fit to log(weight+1) for all available participants’ data (282 girls, 260 boys), and AIC used to identify the best-fitting model. In time-to-event models subsequently fit to the girls’ data to estimate effects of the growth parameters on menarcheal age, a censoring age of 12 years was used to define early puberty.

Results

A model with 4df and fixed and random effects for size and tempo and a fixed effect for velocity was preferred. Some 19% of girls began menstruating before age 12 years. Size and tempo were each associated with an increased hazard of earlier menarche; a 0.1 unit gain in size was associated with a hazard ratio of 1.75 (95%CI 1.32–2.33), and a 0.1 unit gain in tempo with a hazard ratio of 7.84 (95%CI 3.41–18.05).

Conclusions

Using all participants’ data gave more precise growth parameter estimates.

Key messages

Understanding mechanisms that drive increased size and tempo of childhood growth may help to elucidate the links between obesity and girls’ risk of early puberty.
1272Patterns of multimorbidity show strong association between many chronic condition pairs
Authors: Gordon Steph , Baylis Tylie
Published: September 2021

Background

Many people with chronic conditions do not have a single condition: 4.9 million (20%) Australians had multimorbidity (2 or more chronic conditions) in 2017–18. Understanding which conditions co-occur can inform treatment guidelines. This study performs new analysis on Australian Bureau of Statistics 2017–18 National Health Survey data to identify conditions that commonly co-occur, and that co-occur at a higher than expected prevalence.

Methods

Analysis was restricted to people aged 45 and over (most people with multimorbidity). Using 10 selected chronic conditions, weighted age-adjusted estimates of observed and expected events for each combination of 2 conditions were calculated. To identify pairs of conditions that co-occurred at a higher than expected prevalence, the ratio of observed to expected prevalence was assessed using a 95% confidence interval.

Results

Over half of the condition pairs tested were significantly associated. The most strongly associated conditions were asthma with COPD (with co-occurrence 3.5 times as high as expected), diabetes with chronic kidney disease (2.5 times as high), and cardiovascular diseases with chronic kidney disease (2.3 times as high).

Conclusions

Multimorbidity is common, with many conditions co-occurring more frequently than expected by chance. Developing treatment guidelines that consider common multimorbidities would support holistic patient care.

Key messages

Many chronic condition pairs occur together in individuals more often than would be expected by chance. There were strong associations between asthma and COPD, diabetes and chronic kidney disease, and cardiovascular diseases and chronic kidney disease.
454Relationships between sleep traits and metabolic profiles: evidence from multivariable regression and Mendelian randomization analyses
Authors: Goulding Neil , Bos Maxime , Heemst Diana van , Noordam Raymond , Lawlor Deborah
Published: September 2021

Background

Sleep traits are associated with cardiometabolic disease. The aim of this study was to explore the causal effect of sleep traits (duration and insomnia) on multiple metabolic traits.

Methods

We used age, sex and BMI adjusted multivariable regression (N = 17,370) and two-sample summary statistic Mendelian randomization (MR) to examine effects of sleep duration and insomnia symptoms on ∼150 NMR metabolites. Multivariable analyses were conducted on data from nine European cohorts and meta-analysed. MR analyses utilised summary statistics from published genome-wide association studies (GWAS) of self-reported sleep traits (sample 1; N = 446,118 to 1,331,010) and from GWAS on NMR serum metabolites (sample 2; N = 38,618). We used inverse-variance weighted (IVW) for the main MR analyses and weighed median (WM) and MR-Egger to explore bias due to pleiotropy.

Results

MR IVW and multivariable analyses both suggest a positive effect of insomnia symptoms on glycoprotein acetyls (MR: 0.06 s.d. increase in mean concentration comparing any symptoms to none; p = 5.9e-4) and between total sleep duration and creatinine (MR: 0.16 s.d. increase per additional hour; p = 0.03). WM and MR-Egger analyses show consistent results. There was evidence for thirteen and eight effects of insomnia and duration in multivariable only and three and one, respectively, in MR only.

Conclusions

Insomnia symptoms lead to higher levels of an inflammatory marker (glycoprotein acetyls) and longer sleep duration leads to higher creatinine levels.

Key messages

We found no evidence of widespread metabolic disruption by sleep traits.
819Muscle strengthening activities among Australian adults
Authors: Gorrell Lizzie , Monahan Kevin , Groves Chloe , Sparke Claire , Kaya Sarp
Published: September 2021

Focus of Presentation

Australian studies examining muscle-strengthening activity (MSA) are limited and most are focused on resistance/weight training. This study uses the nationally representative Sport Australia AusPlay survey of physical activity participation and classifies activities that use major muscle groups as MSAs, adapting the methodology used in UK health studies. Using this classification, estimates are then made on how many Australian adults are doing MSAs on at least two days a week as per the Australian Physical Activity and Sedentary Behaviour Guidelines.

Findings

There is some uncertainty about which activities can be considered MSAs. However, evidence suggests that many activities, besides resistance/weight training, can strengthen muscles. Three definitions were used to classify physical activities reported by AusPlay respondents as either Resistance Training Only, Definitely MSAs, or Definitely and/or Potentially MSAs. These were applied to AusPlay 2017–18 data to estimate the proportion of adults who met the MSA guideline. For the primary measure of Definitely MSAs, estimates were higher than those from previous Australian studies. Consistent with previous Australian studies, a higher proportion of men than women, and younger adults than older adults, met the MSA guideline across all activity classifications.

Conclusions/Implications

Survey estimates of MSA participation depend on which activities are included as MSAs. More rigorous studies are needed to clearly categorise which activities can be considered as MSAs.

Key messages

A clearer understanding of what constitutes MSAs will improve estimates of how many Australian adults are meeting the MSA guidelines.
702To determine socio-demographic corelates of reproductive tract infection amongst women of reproductive age group
Authors: Gupta Anmol
Published: September 2021

Background

Reproductive tract infection (RTI) is a public health problem, in developing countries like India. The associated odium with it is a stumbling block in seeking health care. So, our aim was to studyprevalence of RTI symptoms and its socio-demographic corelates.

Methods

A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymousinterview schedule was administered after taking consent.

Results

The prevalence of self-reported RTI’swas found to be 41.2%.It was more in lower socio-economic classes, and was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.

Conclusions

RTI infections were more prevalent among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health.

Key messages

The relevant and robust data on RTI’s, may be secured by capacity building of health workers. An exemplary drug supply system may be ensured, so that the RTI kits are available at government health institutions. An introduction of affordable point-of-care tests for sexually transmitted infection may be done, as recommended in the WHO Global Health Sector Strategy for the control and prevention of STIs.
519Innovative use of MedicineInsight GP database for applied research on antibiotic prescribing in Western Australia
Authors: Harrison Amy , Robinson Suzanne , Selvey Linda , Moorin Rachael , Harris Mark
Published: September 2021

Focus of Presentation

This project showcases the use of existing general practice (GP) datasets to gain access to large-scale data for epidemiological research. There is limited quantitative research on antibiotic prescribing in Australian GP. The research question involves identifying predictors of antibiotic prescribing not in accordance with national therapeutic guidelines for urinary tract infection (UTI) in Western Australian (WA) GP. This requires large-scale, individual-level data, which is difficult to access in Australia, and in this case could not be achieved without collaboration.

Findings

Longitudinal records from 52 practices in WA participating in MedicineInsight were analyzed. GP datasets present challenges regarding cleaning, processing and storage. Substantial broad-spectrum antibiotic prescribing was identified in initial episodes of UTI, particularly for children, and not supported by laboratory pathology. Children received broad-spectrum antibiotics 85% of the time, compared to 58% in women. Mixed-effects logistic regression was used to elucidate patient- and consultation-related factors associated with antibiotic prescribing outside of the guidelines.

Conclusions/Implications

There is evidence of antibiotic prescribing outside of the guidelines for initial presentations of UTI in WA GP. Whilst GP datasets provide insightful information on antibiotic prescribing, it is important to explore these findings with practising clinicians to further understand the drivers behind this behaviour, and this is the next stage of this research.

Key messages

Collaborative partnerships can facilitate access to rich, large-scale datasets capable of answering important research questions in Australian primary care.
709Inequalities and the role of sterilization in modern contraception in low- and middle-income countries
Authors: Hellwig Franciele , Barros Aluisio JD
Published: September 2021

Background

Contraceptive use has increased impressively in the last years. Our aim was to track the proportion of female sterilization in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in terms of wealth.

Methods

Using data from national health surveys carried out since 2010 in 105 countries, we estimated mDFPS, separating according to type of method. Where the share of female sterilization was at least 25%, we analysed wealth inequalities in the share of sterilization by wealth quintiles and Slope Index of Inequality (SII).

Results

We included 20 countries, among which mDFPS varied widely (from 6% in Albania to 94% in Brazil). Female sterilization was reported by more than half of women in India, Dominican Republic, El Salvador, Mexico, and Colombia. Most countries presented higher use of sterilization among the richest, but inequality patterns varied greatly. Higher levels of pro-rich inequality were found for Guatemala and Costa Rica (SII of 0.24 and 0.22, respectively). Higher levels of pro-poor inequality were found for Albania and Brazil (SII of -0.25).

Conclusions

Despite the wider range of methods available, several countries present a large proportion of mDFPS satisfied through female sterilization.

Key messages

Sterilization might be recommended to some couples, however, its role in mDFPS is excessively high. Promotion of long-acting reversible contraceptives should be strengthened as they are easy to use, highly effective and do not eliminate women’s agency about maternity in the future.