bluuebunny/crossref_metadata_2025 huggingface dataset:
1179Intergenerational Effects of Violence on Women’s Perinatal Wellbeing and Infant Health Outcomes in Vietnam
Authors: Do Phuc Huyen , Baker Philip , Vo Van Thang , Tran Xuan Bach , Dunne Michael
Published: September 2021

Background

This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam.

Methods

A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and three months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems.

Results

One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = -1.3).

Conclusions

These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.

Key messages

Mothers with violent and adverse family backgrounds have twice the risk of poor mental health during pregnancy, and their infants have twice the risk of adverse birth outcomes. Social support during pregnancy may have a buffering effect by reducing the long-term impact of childhood traumatic events.
1282Causal inference in multi-cohort studies using the target trial approach
Authors: Downes Marnie , O’Connor Meredith , Olsson Craig A , Burgner David , Goldfeld Sharon , Spry Elisabeth A , Patton George , Moreno-Betancur Margarita
Published: September 2021

Focus of Presentation

Utilising data from multiple cohorts to address causal questions in health research has become increasingly widespread due to a number of advantages. These include improved precision of estimates, in particular to investigate effect heterogeneity as well as rare events and exposures, and the ability to examine the replicability of findings. However, undertaking causal inference in multi-cohort studies also faces several challenges, which makes clear causal thinking even more important than in single-cohort studies. We propose the use of the “target trial” framework for the conduct of causal inference in multi-cohort studies.

Findings

Using two case studies, the first considering the effect of maternal mental health on emotional reactivity and the second examining the influence of exposure to adversity on inflammatory outcomes in childhood, we describe and demonstrate how the target trial approach enables clear definition of the target estimand and systematic consideration of sources of bias. Considering the target trial as the reference point allows the identification of potential biases within each study, so that analysis can be planned to reduce them. Furthermore, the interpretation of findings is assisted by an understanding of the unavoidable biases that may be compounded when pooling data from multiple cohorts, or that may explain discrepant findings across cohorts.

Conclusions/Implications

Use of the target trial framework in multi-cohort studies helps strengthen causal inferences through improved analysis design and clarity in the interpretation of findings.

Key messages

The target trial framework, already well-established for casual inference in single-cohort studies, is recommended for the conduct of causal inference in multi-cohort studies.
220Longitudinal associations between social isolation and cognitive performance among middle-aged and older population in China
Authors: Duan Yanran , Ma Yilei , Yin Ping
Published: September 2021

Background

In China, more than 10% of the elderly suffer from cognitive impairment and there is more than 10 million elderly with Alzheimer's disease. We aim to examine the association between social isolation and cognitive function among the Chinese middle-aged and older population.

Methods

We used data from the China Health and Retirement Longitudinal Study (CHARLS). Cognitive performance and social isolation were assessed at baseline (2011) and follow-up (2013, 2015). We examined the trajectories of changes in cognitive performance and social isolation on the Latent Growth Model (LGM), and the independent effects of social isolation on the initial level and the subsequent development of cognition.

Results

After excluding respondents with missing key variables, we ultimately included 10,906 participants in the analysis. Cognitive performance and social isolation scores showed significant differences across time. After adjustment for the confounders, the coefficients of social isolation in the LGM indicated negative effects on cognitive performance in participants at three-time points (P < 0.05). Controlling for the confounders, the path coefficient of the initial level of social isolation with the initial level and the slope of cognition was −1.53 and 0.22, respectively. Similarly, the slope of social isolation and the slope of cognition were significantly (negatively) correlated.

Conclusions

Results demonstrate that higher social isolation lowers the cognitive performance and the decrease in overall social isolation is significantly associated with an increase in cognition for the middle-aged and elderly persons.

Key messages

Cognition, Social isolation, Aging, Latent growth model
1273Confounding in the association between pregnancy complications and subsequent preterm birth
Authors: Dunne Jennifer , Tessema Gizachew Assefa , Pereira Gavin
Published: September 2021

Background

Underlying causal mechanisms that persist from pregnancy to pregnancy have potential to explain recurrence of pregnancy complications. We aimed to estimate the degree of confounding necessary to explain these associations.

Methods

This was a retrospective cohort study of women (n = 124,936) giving birth to their first and second singleton children in Western Australia 1998-2015, identified from the Midwives’ Notifications System. The investigated pregnancy complications were preterm birth (<37 gestational weeks), pre-eclampsia, placental abruption, small-for-gestational-age and perinatal death. Adjusted relative risks (RR) and confidence intervals (CI) were reported. We simulated maternal obesity and derived E-values, a method to determine the magnitude of unmeasured confounding.

Results

Complications in first pregnancy were associated with higher risk of preterm birth in second pregnancy. RR’s were significantly higher when the complication was recurrent. For the association between pre-eclampsia at first term birth and subsequent preterm birth, the RR increased from 1.2 (95% CI 1.05-1.41) to 11.9 (95% CI 9.52-11.49) when the complication reoccurred. E-values were 1.73 and 23.22 respectfully. Relative risks did not change after adjustment for maternal obesity.

Conclusions

The strong associations between pregnancy complications and preterm birth support the assumption of shared underlying causes that persist from pregnancy to pregnancy. High E-values suggest that recurrent confounding is unlikely, as any such unmeasured confounder would have to be uncharacteristically large.

Key messages

Well-established single confounders cannot explain away the strong associations between complications in first pregnancy and a subsequent preterm birth.
742Analyzing the statistical pitfalls of treating mediators as confounders
Authors: Elmrayed Seham , Fenton Tanis , Metcalfe Amy , Brenner Darren
Published: September 2021

Background

Numerous studies indicated that infants born small-for-gestational-age (SGA) are at higher risk of overweight. However, the association between SGA and overweight may be due to overcontrolling for body size. This study aimed to analyze the effect of controlling for child’s weight and height in the association between SGA and overweight in children born preterm.

Methods

Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). The association between SGA and overweight at 36 months corrected age (CA) was analyzed using logistic regression models: 1) crude, 2) adjusted for baseline covariates, 3) adjusted for baselines covariates with additional adjustments separately for child’s weight and height at 21 months CA. Marginal structural models (MSM) with stabilized inverse probability weights were used to estimate the direct effect of SGA on overweight.

Results

The crude and adjusted models yielded a null association (OR, 95% CI: 0.88, 0.26-2.96; 0.95, 0.28-3.29). Adjusting for later height reversed the effect (OR, 95% CI: 2.31, 0.52-10.26), and adjusting for later weight reversed the effect and provided a significant association (OR, 95% CI: 6.60, 1.10-37.14). The MSMs with height and weight considered as mediators indicated no direct effect of SGA on overweight (OR, 95% CI: 0.83, 0.14-5.01; 0.71, 0.18-2.81).

Conclusions

Overcontrolling for body size can falsely induce an association between SGA and overweight.

Key messages

Mediators should not be treated as confounders.
1086Methodological challenges using routine aggregated data in a primary care implementation trial on opioid prescribing
Authors: Farragher Tracey , Alderson Sarah , Carder Paul , Willis Tom , Foy Robbie
Published: September 2021

Focus of Presentation

There is international concern over rising trends in opioid prescribing, largely attributed to prescribing for chronic non-cancer pain. We conducted a controlled interrupted time series study on anonymised, aggregated practice data to evaluate the effect of the Campaign to Reduce Opioid Prescribing (CROP) in reducing the number of patients taking opioid medication in West Yorkshire UK practices targeted by the feedback intervention, compared to practices outside of West Yorkshire. We will discuss the methodological challenges addressed in the collection and analysis of these data, and the implications for using routine data in trials.

Findings

Primary care data sources for feedback interventions include large-scale databases (General Practice Research Database), high-level nationally gathered databases (OpenPrescribing.com) or data extracted directly from electronic health records (EHR). We will discuss the implications of the different sources of data and compare the results from each, in understanding the impact of the feedback intervention of reducing opioid prescribing over time. The consequences of the heterogeneity of the data sources on the interrupted time series analysis undertaken will also be discussed and solutions outlined.

Conclusions/Implications

Routine data are heterogeneous, with different purposes, structures and collection methods, which have considerable implications on their use, analysis and interpretation. Researchers need to understand that the utility of routine data sources have implications (both practically and methodologically) in conducting pragmatic trials, which should be considered when planning and conducting future studies using routine data.
1514Racial discrimination and anxiety symptoms in adolescents and young adults: a five-wave longitudinal analyses
Authors: Feijó Fernando , Feitosa Caroline , Salvi Leonardo , Gusmão Aline , Campos Felipe , Santana Vilma
Published: September 2021

Background

Racism is a major public health issue and may be associated with several mental health outcomes. However, more epidemiological analyses are necessary on the theme, particularly longitudinal studies. Therefore, we aimed to examine the association between perceived racial discrimination and anxiety symptoms during adolescence and young adulthood in a Brazilian metropolitan area.

Methods

A five-wave prospective longitudinal study started in 2000. Individuals were aged from 10 to 21 years at baseline, with clustered random sampling. Questions about the experience of racial discrimination were asked. PHQ-9 evaluated anxiety symptoms. Repeated measures analysis with GEE (Generalized Estimating Equations) estimated adjusted relative risks.

Results

There were 979 adolescents at baseline, with 19.9% (n = 195) reporting perceived racial discrimination and 26.5% (n = 259) with anxiety symptoms. A positive association was found between the perception of racism and anxiety symptoms, after adjustment for sex and age. When adding socioeconomic status, work and adverse environmental conditions, in the final adjusted model, the association was not substantially affected (RR = 1.52; 95% CI: 1.30-1.79).

Conclusions

The fight against racism and different types of discrimination and racial violence are urgent for public health. To assure high levels of ethical values and respect for fundamental human rights is still a challenge in the Brazilian society, still marked by the historical and shameful experience of slavery. Public policies, including health policies, in particular, must target the elimination racial discrimination as a central topic, reducing its consequences for mental health of black population.

Key messages

This study advances by adding a longitudinal analysis to a theme with a lack of epidemiological studies, especially longitudinal ones, contributing to the understanding of the association between racism in adolescence and mental health. The findings highlight the urgent need to fight racial discrimination as an ethical paradigm, reducing severe consequences of this type of violence on mental health.
195The Health4Life Initiative: An eHealth intervention targeting multiple lifestyle risk behaviours among Australian adolescents
Authors: Gardner Lauren , Champion Katrina , Teesson Maree , Newton Nicola , Kay-Lambkin Frances , Chapman Cath , Thornton Louise , Slade Tim , Mills Katherine , Sunderland Matthew , Allsop Steve , Hides Leanne , McBride Nyanda , Bauer Judith , Parmenter Belinda , Spring Bonnie , Lubans David
Published: September 2021

Background

Physical inactivity, poor diet, sedentary recreational screen time, poor sleep, alcohol use and smoking (the “Big 6”) are key lifestyle risk factors for chronic disease. The Big 6 typically emerge during adolescence, co-occur and continue into adulthood. To improve short- and long-term health, early and effective prevention is critical.

Methods

A cluster randomised controlled trial (ACTRN12619000431123) is being conducted in 71 schools across NSW, QLD and WA. Schools are randomised to the Health4life intervention or health education as usual. The intervention has three components: 1) An online, school-based program delivered to all Year 7 students; 2) An accompanying smartphone application (all students); 3) Booster content, delivered to at-risk students in Years 8 and 9. Students complete questionnaires on five occasions over three years.

Results

Preliminary analyses including 6716 students (49% female) indicated that 22% of participants met national guidelines for physical activity, 27% reported drinking 2+ cups of sugar-sweetened beverages/week, 3% had consumed a standard alcoholic drink in the prior 6 months, 2% had tried smoking, 86% engaged in excessive recreational screen time, and 32% had inadequate sleep. The final dataset will be analysed for the conference.

Conclusions

Many Australian adolescents are engaging in lifestyle behaviours that put them at risk of chronic disease. Effective and scalable preventive interventions that simultaneously target these behaviours are needed.

Key messages

This is the first trial of an eHealth intervention to concurrently target the Big 6 among adolescents. Health4Life has the potential to improve physical and mental health in adolescence and beyond.
245Comparison of methods for classifying heterogeneity in gestational diabetes (GDM) and association with outcomes
Authors: Gibbons Kristen , McIntyre David , Ma Ronald , Tam Wing Hung , Madsen Lene Ring , Sacks David , Catalano Pat
Published: September 2021

Background

Clinical experience suggests that diverse clinical subtypes exist within the broader diagnosis of GDM. Analysis from a single centre recently outlined heterogeneity in GDM with respect to insulin secretion and sensitivity, defining four GDM subtypes: 1) GDMsecr (<25th centile HOMA-β (Hb) for non-GDM); 2) GDMsens (<25th centile Matsuda Index for non-GDM); 3) GDMmixed (both GDMsecr and GDMsens); 4) GDMND, no defect (neither GDMsecr and GDMsens). Classification using these subtypes is associated with adverse outcomes.

Methods

Following similar methodology, women with GDM were classified into four subtypes including comparison of Hb, insulinogenic index (II) and Stumvoll first-phase estimate (SV) for defining GDMsecr. Analyses compared neonatal outcomes with non-GDM women and between GDM groups using c2 tests and regression analyses adjusted for multiple confounders including maternal age, BMI and HAPO study centre.

Results

Hb, II and SV gave divergent results for GDMsecr, with only 19% concordance. In all analyses, GDMND (10% by Hb, 6% by II, 6% by SV) showed outcome frequencies similar to those of non-GDM women; groups 1-3 showed higher risks (p < 0.01 vs non GDM). These results persisted in the fully adjusted model (aOR generally >2.0).

Conclusions

Different clinical subtypes in GDM are associated with differing risks of adverse outcome.

Key messages

Determination of GDM subtype can assist in assessing GDM women at higher risk of adverse clinical outcome and help guide clinical practice.
1399Associations of family wellbeing with face-to-face and instant messaging family communication amidst the COVID-19 pandemic
Authors: Gong Weijie , Sit Shirley Man Man , Lai Agnes Yuen Kwan , Wu Socrates Yongda , Wong Bonny Yee Man , Ho Sai Yin , Lam Tai Hing , Wang Man Ping
Published: September 2021

Background

Face-to-face communication has reduced amidst the COVID-19 pandemic. We examined the associations between family communication and family wellbeing.

Methods

In an online survey of the Hong Kong Jockey Club SMART Family-Link Project in May 2021, 4981 Hong Kong Chinese adults (mean age 43.5 years, response rate 24.3%) reported family communication methods of face-to-face and instant messaging (IM) when the COVID-19 pandemic was severe (yes/no), communication contents that were neutral, positive, supportive, and negative (yes/no), and communication quality (0-10). The associations of family wellbeing (health, happiness, and harmony, 0-10) with communication methods and contents were examined using linear regression (β), adjusting for each other, sex, age, socioeconomic status, and number of cohabitants. The mediating effects of communication quality on these associations were examined. Prevalence estimates were weighted by sex, age and education of general population.

Results

7.1% respondents reported no communication, 12.7% face-to-face only, 26.7% IM only, and 53.4% both. More communication contents were neutral (range 83.1-99.3%) than positive (42.1-62.2%), supportive (37.5-54.8%), and negative (10.9-34.5%). Communication quality was highest in using both methods (6.7 vs 4.5-6.6, all P≤0.02). Better family wellbeing was associated with using IM only (adjusted β: 0.37) and both methods (0.37) than face-to-face only and with positive (0.62) and supportive (0.45) contents (all P≤0.001). Communication quality mediated 35.2-93.5% of these associations.

Conclusions

Better family wellbeing was associated with IM and face-to-face communication and their contents, partly through communication quality.

Key messages

Family IM communication with positive and supportive contents may enhance family wellbeing amidst the COVID-19 pandemic.
1260Contribution of risk factors to disease burden in Australia in 2018
Authors: Gourley Michelle ,   Australian Burden of Disease Study team
Published: September 2021

Background

The Australian Burden of Disease Study 2018 estimated the burden due to 219 diseases and injuries and 40 risk factors (attributable burden). Attributable burden is the amount of health loss that would be prevented if exposure to the risk factor had been avoided or reduced to the lowest possible exposure.

Methods

Attributable burden was estimated for 2003, 2011, 2015 and 2018 using comparative risk assessment methodology. Estimates of exposure to risk factors were sourced from Australian survey data and used with global measures of effect size to estimate population attributable fractions (PAFs).

Results

In 2018, 37% of the burden of disease in Australia could have been prevented by reducing or avoiding exposure to the modifiable risk factors included in the study. The leading five risk factors contributing to total burden were: tobacco use (8.6%), overweight & obesity (8.4%), dietary risks (5.4%), high blood pressure (5.1%) and alcohol use (4.5%). While tobacco use remains the leading risk factor causing burden, the gap between tobacco use and overweight & obesity has almost closed. The burden attributable to most risk factors was higher in males than in females. The lowest socioeconomic group experienced greater burden compared with the highest group for all risk factors.

Conclusions

Addressing modifiable risk factors could prevent up to 37% of disease burden in Australia.

Key messages

In 2018, 37% of the burden of disease could have been prevented. Tobacco use and overweight & obesity were the leading risk factors.
1469Inequalities in diabetes management by area deprivation: the mediating role of healthcare resource distribution
Authors: Ha Rangkyoung , Jung-Choi Kyunghee
Published: September 2021

Background

We sought to identify the existence of regional socioeconomic inequalities in diabetes management and to examine whether the distribution of healthcare resources could explain regional inequalities in diabetes management.

Methods

Data were derived from the Korean Community Health Survey in 2018. Our study subjects included 23,760 participants who have been diagnosed with diabetes by a doctor. The dependent variables were self-reported glycemic control, Hemoglobin A1c (HbA1c) testing, recognition of the term HbA1c, and diabetic complications testing. Socio-demographics, health behavior-related factors, and factors related to regional healthcare resources were considered as potential mediating variables in explaining the association between diabetes management and area deprivation. A multilevel logistic regression analysis was used.

Results

Compared to the least deprived area, the likelihood of not taking HbA1c tests, not recognizing the term HbA1c, and not taking diabetic complication tests in the most deprived area were approximately 1.5, 2.6, and 2 times higher, respectively. In the most deprived areas, the coefficient of variation value of clinics was the highest and the number of doctors was the lowest. Regional healthcare resource factors explained regional inequalities in managing diabetes by 14% to 18%, especially in the most deprived area.

Conclusions

Policy interventions for more even distribution of healthcare resources would contribute to reducing the magnitude of regional inequalities in diabetes management.

Key messages

Our study suggests that reducing inequality in diabetes management could be possible through the appropriate allocation of healthcare resources.
315A new strategy for teaching Epidemiology in Public Health Education: Hybrid Team Based Learning-Personalised Education
Authors: Ha Tam , Kemp Byron , Wallace Margaret
Published: September 2021

Focus of Presentation

Hybrid Team Based Learning and Personalised Education (HTBL-PE) is an unique student-centred teaching strategy used to teach epidemiology in the Bachelors of Public Health at the University of Wollongong. It aims to systematically build abilities in epidemiology; strengthen self-confidence and belief, by teaching the way students learn and harnessing team’s capabilities to strengthen the individual.

Findings

73 out of 84 students enrolled in Spring 2019, completed surveys at the beginning and end of semester (87%). At the end of semester, the vast majority of students indicated their interest in epidemiology increased (93%), critical thinking had improved (92%), and their confidence as independent learners had increased (86%). More than two thirds of the students had already applied learnings from this subject in other settings (67%). In general, these outcomes did not differ significantly by gender or across learning styles. Students’ final mark for this subject was significantly higher than their Weighted Average Mark (WAM) prior to the semester (+17.4, p < 0.001). Mean scores were >84/100 overall for the subject (<0.5% failure rate).

Conclusions

HTBL-PE is a new, innovative teaching strategy with low failure rates and high mean scores. Successful attainment of learning outcomes did not differ across gender or learnings styles.

Key messages

HTBL-PE is an effective teaching strategy with positive student outcomes. It caters to a variety of students and learning styles with evidence students have applied these techniques to other learning settings.
440Women and children’s experiences of international male migration for labour in Nepal
Authors: Stevens Kaila , Heyworth Jane , Dantas Jaya , Reid Alison , Saunders Julie
Published: September 2021

Background

At least 10% of the Nepalese population is estimated to be working abroad. Typically, those abroad are young men with families from agricultural backgrounds. Research regarding the impact on the family left behind in Nepal is growing but has focused on singular issues rather than the multifaceted effects of migration. This study aimed to gain an in-depth understanding of the challenges and benefits of migration for wives and children left behind.

Methods

Thirty-two qualitative semi-structured interviews were undertaken in Kathmandu and Kaski districts of Nepal. Eligible participants were women who had a husband who had migrated abroad for work and a child under the age of five. Interviews were conducted in Nepali, translated and transcribed to English, then coded and analysed using inductive Thematic Analysis.

Results

Three overarching themes were developed: Migration as a livelihood strategy, Migration as a trade-off, and Adaptation to the situation. The financial benefits of migration included improvements in children’s education and access to food and housing. Challenges identified were women’s increased labour burden inside and outside the home, psychosocial stress, and changed child-father relationships. Change in women’s empowerment was dependent on socio-demographic factors.

Conclusions

Migration often resulted in the improvement of economic circumstances. However, challenges being faced by women and children largely shifted from financial to emotional.

Key messages

The effects of migration are mediated by contextual factors. Given the ongoing reliance on migration for work, strategies should be employed to optimise the benefits and mitigate the consequences of those who remain.
651The voice of Indian women on family planning: A qualitative systematic review and meta-synthesis
Authors: Hoogar Praveen , Pujar Ashwini , Dhyani Vijay Shree , Parsekar Shradha S.
Published: September 2021

Background

This systematic review and meta-synthesis was conducted to explore the views and experiences of women on family planning in India.

Methods

We included qualitative studies conducted in India and published in English. PubMed, SCOPUS, Web of Science, CINHAL and ProQuest were searched from inception till April 2019. Population of interest were women in reproductive age group. Additionally, husband of the woman and mother-in-law were eligible to be included. Studies conducted among HIV positive, commercial sex workers and drug addicts were excluded. Selection of studies (titles, abstracts and full tests screening), data extraction and methodological quality assessment (using CASP checklist) was undertaken independently by four authors in pairs. Any discrepancies were resolved by discussion until consensus. Thematic analysis was used to analyse the data (PROSPERO registration number CRD42018093960).

Results

We included 39 full texts through database and reference searching. Most of the women were married. Main themes were; ‘family influence’, ‘perceived benefits/harm of son/daughter’, ‘perceived misconception of contraception’, ‘socio-cultural norms’, ‘abortion as a family planning option’, ‘healthcare reach and mistrust’ and ‘demographic dividend’.

Conclusion

There is a need to include husband and mother-in-law while delivering messages or strategies to women on family planning in India. Traditional norms are deep rooted in the community therefore, family planning strategies should be context and need based.

Key message

Meta-synthesis is a promising approach to gather evidence of complex health problems that require an understanding of social and cultural determinants of health.
399The causal effect of BMI on neurodevelopment: a within family Mendelian randomization study using MoBa
Authors: Hughes Amanda , Morris Tim , Ayorech Ziada , Tesli Martin , Ask Helga , Askeland Ragna , Reichborn-Kjennerud Ted , Johansson Stefan , Andreassen Ole , Magnus Per , Helgeland Øyvind , Njølstad Pål , Smith George Davey , Davies Neil , Howe Laura , Havdahl Alexandra
Published: September 2021

Background

Higher BMI in childhood predicts subsequent neurodevelopmental and emotional problems, but it is unclear if associations are causal. Observational studies are vulnerable to reverse causation and confounding. Mendelian randomization (MR) studies with unrelated individuals can also suffer from familial biases, such as dynastic effects (“genetic nurture”).

Methods

We apply within-family MR (WFMR) to overcome these biases. We used genetic information from 26,370 family trios in the Norwegian Mother, Father and Child Cohort Study (MoBa) to construct BMI polygenic scores in children and both parents. By using all three polygenic scores to instrument BMI, we avoided familial biases affecting previous studies.

Results

Multivariable-adjusted and conventional MR models implied an impact of children’s BMI on depressive, ADHD, and autism symptoms. In conventional MR models, a 5kg/m2 increase in BMI corresponded to depressive symptoms 0.49 SD higher (95%CI: 0.24-0.73), and ADHD symptoms 0.49 SD higher (95%CI: 0.28-0.70). WFMR estimates were less precise but gave little evidence of causal impacts of children’s BMI. Maternal BMI was positively associated with children’s depressive (0.16 SD per 5kg/m2, 95%CI: 0.04-0.28) and autism symptoms, and paternal BMI with children’s ADHD symptoms.

Conclusions

Compared to conventional MR models, MR models accounting for parental genotype found less evidence of causal effects of children’s own BMI on emotional and neurodevelopmental symptoms. The discrepancy may suggest an influence of family or population-level effects.

Key messages

The influence of children’s own BMI on emotional and neurodevelopmental problems may have been overstated. Parental BMI, familial or population level effects may influence these outcomes.
924The landscape of clinical trial activity focusing on Indigenous health in Australia from 2008-2018
Authors: Hunter Kylie , Xu Gemma , Modi Danai , Askie Lisa , Jamieson Lisa , Brown Alex , Seidler Anna Lene
Published: September 2021

Background

There are major health disparities between Indigenous and non-Indigenous Australians. To address this, it is vital to understand the landscape of Indigenous trial activity.

Methods

We extracted data from all Australian trials registered between 2008-2018 on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov. Indigenous-focused trials were identified by searching for relevant terms such as ‘Indigenous’ and ‘Aboriginal’. Indigenous versus non-Indigenous trials and Australian trials overall were compared by conditions studied, intervention type, study design and funding.

Results

Of the 9206 included trials, 139 (1.5%) focused on Indigenous health, and these were mostly in ‘Public Health’ (n = 69, 50%), ‘Mental Health’ (n = 35, 25%) and ‘Cardiovascular’ (n = 25, 18%) (Figure). Compared to other Australian trials, Indigenous trials more frequently studied ear conditions (OR 16.47, 95%CI=8.43-29.99) and public health (OR 4.87, 95%CI=3.65-6.41), and were more likely to focus on screening (OR 3.57, 95%CI=2.10-5.70) and prevention (OR 2.24, 95%CI=1.61-3.08) rather than treatment (OR 0.40, 95%CI =0.30-0.52). They were less likely to be blinded (OR 1.72, 95%CI=1.20-2.49), or have any industry involvement (OR 2.52, 95%CI=1.54-4.43).

Conclusions

Indigenous trials differed from other Australian trials in health conditions studied, intervention focus, blinding and industry involvement. Relative to population size and burden of disease, the number of trials focusing on Indigenous health is low.

Key messages

Trial registries can be used to explore whether research appropriately addresses diverse populations such as Indigenous Australians. This can inform future research prioritisation.
695Gene and environmental factors for liver fibrosis among Japanese general population with NAFLD
Authors: Ibusuki Rie ,   Ippei Shimoshikiryo,   Daisaku Nshimoto,   Hironori Miyahara,   Koichi Tokushige,   Toshiro Takezaki
Published: September 2021

Background

A part of nonalcoholic fatty liver disease (NAFLD) develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Metabolic syndrome is involved in their development, and hepatic fibrosis plays an important role in their pathogenesis. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene encode proteins on hepatic lipid metabolism regulation, and PNPLA3 gene polymorphism is associated with the development and progression of NAFLD. To investigate the gene and environmental factors, and their interaction for liver fibrosis, we conducted a prospective study among Japanese general population with NAFLD.

Methods

The subjects were 295 general residents who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed for 5 years. NAFLD was defined as fatty liver using abdominal ultrasonography. PNPLA3 C/G polymorphism (rs738409) was analysed using TaqMan PCR. Hepatic fibrosis was defined using FIB 4 index (≥1.3). Logistic regression model was used to estimate the odds ratios (ORs) after adjusted for confounding factors.

Results

Mean age was 55.1 years and liver fibrosis was observed at 73.2% among NAFLD subjects. No environmental factors were associated with liver fibrosis, and PNPLA3 GG genotype was not associated with liver fibrosis, too. However, the ORs of CC & CG, and GG genotypes for dyslipidemia was respectively 0.45 (0.19-1.04) and 11.9 (1.81-78.4), and their interaction was significant (p = 0.01).

Conclusions

The interaction between PNPLA3 GG gene polymorphism and dyslipidemia for liver fibrosis was observed.

Key messages

Genetic susceptibility with dyslipidemia may be involved in liver fibrosis of NAFLD.
783Lifetime alcohol intake and stomach cancer risk: a pooled analysis of two prospective cohort studies
Authors: Jayasekara Harindra , MacInnis Robert , Yang Yi , Hodge Allison , Mitchell Hazel , Haydon Andrew , Room Robin , Hopper John , Gunter Marc , Riboli Elio , Giles Graham , Milne Roger , English Dallas , Ferrari Pietro
Published: September 2021

Background

Alcohol consumption is causally linked to several cancer sites but the evidence for stomach cancer is still inconclusive. We aimed to quantify the association between alcohol intake and risk of stomach cancer, including subtypes.

Methods

We pooled data from two cohort studies including 452,958 individuals enrolled in the European Prospective Investigation into Cancer in 1992-98 and 38,756 Australians enrolled in the Melbourne Collaborative Cohort Study in 1990-94. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident stomach cancer were estimated using Cox regression.

Results

1,225 incident stomach cancers were diagnosed over 7,094,637 person-years. Alcohol intake was not associated with overall stomach cancer risk. We observed a weak positive dose-response association for lifetime intake with non-cardia stomach cancer (HR = 1.03, 95% CI: 1.00-1.06/per 10 g/day increment), which is the more common type (77.6% of cases), and a weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) (phomogeneity=0.006). These associations did not differ appreciably by smoking or Helicobacter pylori infection status. Differences in HRs between diffuse-type and intestinal-type cancer were minimal (phomogeneity=0.97). HRs of 1.50 (95% CI: 1.12-2.01) for non-cardia and 0.53 (95% CI: 0.27-1.02) for cardia cancer were observed for a life course trajectory characterised by sustained heavy drinking compared with light drinking (phomogeneity=0.01).

Conclusions

Lifetime alcohol intake was associated with increased risk of non-cardia stomach cancer. The inverse association for cardia cancer indicates aetiologic differences between subsites.

Key messages

Limiting long-term alcohol consumption, and avoiding heavy use in particular, might be beneficial in preventing non-cardia stomach cancer.
473Preventable pertussis burden in Australia within the first year of life by improving vaccination timeliness
Authors: Jayasundara Duleepa , Randall Deborah , Sheridan Sarah , Sheppeard Vicky , Liu Bette , Richmond Peter , Blyth Christopher , Wood James G , Moore Hanna C , McIntyre Peter B , Gidding Heather F
Published: September 2021

Background

Previous Australian studies have shown that on-time Diphtheria-Tetanus-Pertussis (DTP) vaccination coverage is 50-60% in certain subpopulations. We estimated the potentially preventable burden of pertussis if, 1) the full primary course and, 2) each dose was given on-time.

Methods

Perinatal, immunisation, pertussis notification, and death data were linked for 1,412,984 infants born in two Australian states in 2000-2012. A DTP dose administered >15 days after the recommended age was categorised as delayed. For aim 1, pertussis rates up to 1-year of age were compared in infants with ≥1 dose delayed versus all doses on-time, using Poisson regression methods. For aim 2, the expected number of cases preventable by each dose was calculated as the product of the number of cases observed during the period of delay and (1 – dose-specific vaccine effectiveness).

Results

58% of infants had all primary DTP doses on time. We estimated that 85 (95% CI: 61-109) cases per 100,000 infants, aged 39-days to 1-year, could have been prevented if all infants had been vaccinated on time; 77% of these infants had received ≥1 DTP dose within the first year of life. Estimated preventable burden attributable to delayed DTP1 (58/100,000) was higher than for DTP2 (26/100,000) and DTP3 (15/100,000).

Conclusions and Key messages

Poor vaccine timeliness, especially delayed DTP1, is a key contributor to the residual burden of pertussis. These findings can inform cost-benefit analyses of targeted programs and public health messaging to reduce delays.
807Association between diabetes and adjuvant chemotherapy implementation among patients with stage III colorectal cancer
Authors: Kanehara Rieko , Goto Atsushi , Watanabe Tomone , Inoue Kosuke , Taguri Masataka , Kobayashi Satoshi , Imai Kenjiro , Saito Eiko , Katanoda Kota , Iwasaki Motoki , Ohashi Ken , Noda Mitsuhiko , Higashi Takahiro
Published: September 2021

Background

Preexisting diabetes may contribute to the indication for adjuvant chemotherapy among patients with colorectal cancer (CRC); however, the association between diabetes and its implementation is largely unknown.

Methods

We analyzed the hospital-based cancer registry and health claims data of patients with stage III CRC who received curative surgery in 2013 in Japan (n = 6,344). Chemotherapy and diabetes was identified based on procedure, prescription, and diabetes codes in claims data. We examined the association between diabetes and implementation rate of adjuvant chemotherapy using the generalized linear model adjusted for age, sex, and updated Charlson Comorbidity Index, hospital type, and prefecture. We further applied a mediation analysis to examine the extent to which postoperative complications mediated the association.

Results

Of these, 1,236 (19.5%) had diabetes. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate: 58.9% and 49.8%; adjusted percentage point difference: 4.7% [95% confidence limits: 1.7, 7.5]). Mediation analysis indicated that postoperative complications explained 9.4% of the association between diabetes and adjuvant chemotherapy implementation.

Conclusions

Our findings suggest that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications may partially account for the association.

Key messages

Concomitant diabetes might negatively impact the implementation rate of adjuvant chemotherapy in patients with stage III CRC.
1496Spatiotemporal patterns of Kawasaki disease in South Korea: using 2008-2017 national representative data
Authors: Kim Jeehyun , Hong Kwan , Yum Sujin , Gómez Raquel Elizabeth Gómez , Chun Byung Chul
Published: September 2021

Background

Despite the etiology of Kawasaki Disease (KD) remains unknown, identifying spatiotemporal clusters of KD could support its hypothesis to be infectious disease. However, spatiotemporal clusters of KD have never been reported in South Korea. Therefore, this study aims to analyse the spatiotemporal patterns of KD in South Korea using national representative data.

Methods

We extracted epidemiologic-week (Epi-week) based KD case (ICD-10-CM code, M303) from 2008-2017 national health insurance service data in municipal level. To determine whether spatial autocorrelation and municipal-level clusters exist, year, sex, and age group (<5, 5-9) stratified Global Moran’s I statistics and LISA spatial scan statistics on KD incidence were conducted.

Results

A total of 98,503 cases of KD were reported in 2008-2017 (aged <5: 72,562 cases [73.7%]). Mean diagnosis age was 4.2±7.0 years, and male-to-female ratio was 1.39:1. Incidence among patients aged <5 increased since 2008; the highest in 2016 (396.78 per 100,000 population). KD had seasonality of winter and summer. Epi-week 46-52 was the most frequent season for cases aged <5, while Epi-week 1-5 was the most frequent season for cases aged 5-9. Positive spatial autocorrelation was consistently reported in every stratum except for ‘2012year/female/age5-9’ and ‘2015year/female/age5-9’ stratum. High-high clusters were consistently detected in the eastern part of South Korea in every stratum.

Conclusions

South Korea had steady increase in KD incidence since 2008 and municipal-level clusters throughout 2008-2017.

Key messages

Kawasaki disease in South Korea had spatiotemporal patterns.
886Serum folate and risk of disabling dementia: Community-based nested case-control study
Authors: Kishida Rie , Yamagishi Kazumasa , Maruyama Koutatsu , Ikeda Ai , Kubota Yasuhiko , Hayama-Terada Mina , Muraki Isao , Shimizu Yuji , Umesawa Mitsumasa , Cui Renzhe , Imano Hironori , Sankai Tomoko , Okada Takeo , Kitamura Akihiko , Kiyama Masahiko , Iso Hiroyasu
Published: September 2021

Background

Folate regulates homocysteine metabolism and high blood homocysteine level has been associated with risk of dementia. Accordingly, serum folate is hypothesized to decrease the risk of dementia but epidemiological evidence, especially for Japanese, is scant. The aim of this study was to examine associations between serum folate and risk of disabling dementia within a Japanese cohort over 20 years of follow-up.

Methods

We performed an intracohort case-control study nested in a community-based cohort, the Circulatory Risk in Communities Study (CIRCS), involving 13934 Japanese individuals aged 40-84 years at the baseline period of 1984-2005. Serum folate was measured in 511 cases of incident disabling dementia, and in 1022 controls whose age (±1 years), sex, area, and baseline year were matched with the cases. The diagnosis of disabling dementia was performed by attending physicians under the National Long-Term Care Insurance System in Japan. Conditional odds ratios of disabling dementia according to quintiles of serum folate were calculated using conditional logistic regression models.

Results

Serum folate was inversely associated with risk of disabling dementia. The multivariate odds ratios (95% confidence intervals) were 0.62(0.43-0.88), 0.71(0.49-1.00), 0.63(0.43-0.91), and 0.51(0.34-0.76) for persons with the second, third, fourth, and highest quintiles of serum folate, respectively, compared with the lowest quintiles (P for trend = 0.19).

Conclusions

Low serum folate level was associated with increased risk of disabling dementia among Japanese.

Key messages

e Low folate intake may have an adverse effect on developing dementia.
704The preventable future burden of cancer in Australia
Authors: Laaksonen Maarit A , Canfell Karen , MacInnis Robert , Arriaga Maria E , Hull Peter , Banks Emily , Giles Graham G , Mitchell Paul , Cumming Robert G , Byles Julie E , Magliano Dianna J , Shaw Jonathan , Gill Tiffany K , Hirani Vasant , Marker Julie , McCullough Susan , Klaes Elizabeth , Connah David , Velentzis Louiza S , Vajdic Claire M
Published: September 2021

Background

Estimates of the future burden of invasive cancer attributable to current modifiable causal exposures can guide cancer prevention.

Methods

We linked pooled data from seven Australian cohort studies (N = 367,058) to national cancer and death registries, and estimated exposure-cancer and exposure-death associations using adjusted proportional hazards models. We estimated exposure prevalence from contemporary national health surveys and calculated population attributable fractions (PAFs) and 95% confidence intervals, using advanced methods accounting for competing risk of death.

Results

Current levels of past and current smoking explain 36.1% (95%CI 33.2%-38.9%), body fatness 13.6% (10.9%-16.2%) and alcohol consumption exceeding two drinks/day 2.3% (1.0%-3.6%) of cancers causally related to these exposures, corresponding to 210,000, 81,300 and 14,800 cancers in Australia in the next 10 years, respectively. Ever smoking is the leading modifiable cause of lung (82.1%), bladder (49.8%), oesophageal (42.8%), liver (39.8%), head and neck (35.6%), and pancreatic (21.3%) cancer burden. Body fatness is the leading modifiable cause of corpus uteri (42.5%), gastric cardia (33.6%), renal cell (29.1%), thyroid (20.1%), colorectal (12.6%) and postmenopausal breast (12.6%) cancer burden. The absolute numbers of cancers in the next 10 years attributable to smoking are highest for lung cancer (114,000). The numbers of cancers attributable to body fatness and alcohol are highest for colorectal cancer (23,000 and 9,900, respectively).

Conclusions

More reliable advanced methods demonstrate large proportions and numbers of cancers are preventable by modifying behaviours.

Key messages

Ever smoking and body fatness are the leading causes of preventable future burden of causally related cancers in Australia.