bluuebunny/crossref_metadata_2025 huggingface dataset:
1507A cross sectional study on respiratory morbidity among traffic police personnel in Hyderabad, Telangana
Authors: Wassey Abdul , Afreen Ishrath , Lakshman Rao RL
Published: September 2021

Background

Occupational hazards cause early deaths to millions of people worldwide and result in avoidable morbidity that adversely affect the quality of life. The problem of air pollution is also addressed in two of the Sustainable Development Goals (SDGs) – SGD3 and SDG11. Traffic police are one of the worst sufferers because they are continuously exposed to the toxic pollutants emitted from the automobiles.

Methods

A community based cross-sectional study was carried out from June 2016 to October 2017 among traffic police personnel of Hyderabad district, Telangana. The study was done with a sample size of 270. Data collection was done using a standardized pretested structured schedule developed using ATS-DLD questionnaire, Peak Expiratory Flow Rate (PEFR) measurements and spirometry for lung volumes.

Results

The average roadside working hours per day for the study participants was 6 hrs per day. The prevalence of respiratory morbidity was found to be 29.85%. Chronic phlegm, chronic cough and chronic wheeze was reported in 18.99%, 13.17%, 2.32% respectively. Respiratory morbidity was significantly associated with age, duration of occupation related exposure to air pollution and the Air Quality Index of workplace (p < 0.05). Around 29% showed obstructive pattern Peak Expiratory Flow Rate (PEFR). Around 68% had FEV1 less than 80% predicted.

Conclusions

The respiratory morbidity may be attributed to the harmful effects of air pollution due to vehicular exhaust.

Key messages

Respiratory morbidity among traffic police personnel in Hyderabad warrants implementation of preventive measures.
64Traditional Japanese Diet Score and cancer incidence and mortality - a 23-year longitudinal global study
Authors: Abe Chisato , Imai Tomoko , Sezaki Ayako , Miyamoto Keiko , Kawase Fumiya , Shirai Yoshiro , Inden Ayaka , Kato Takumi , Sanada Masayo , Shimokata Hiroshi
Published: September 2021

Background

Traditional Japanese diets are considered to be one cause of Japanese health and longevity. We created a Traditional Japanese Diet Score (TJDS) and investigated the relationship between the TJDS and cancer during more than 20 years using global database.

Methods

Total cancer incidence and mortality by country were identified from the Global Burden of Disease 2017 database. Average food supply (g/day/capita) and energy supply (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations database. The TJDS by country was calculated from nine food groups, the higher scores mean the more adherence to traditional Japanese diet. That is beneficial food groups (rice, fish, soybeans, vegetables, eggs, seaweed) gave positive points to high supply amount, and food groups not commonly used in the Japanese diet (wheat, milk, and red meat) gave minus points to high supply amount. The longitudinal associations between the TJDS and cancer incidence and mortality controlled for covariates were examined during 23 years from 1990 to 2013. The country covered by this study was 139 countries with populations of 1 million or greater.

Results

The TJDS was negatively associated with cancer incidence and mortality longitudinally in a linear mixed-effect model controlled for covariates.

Conclusions

These results suggest that greater adherence with the TJDS supressed cancer incidence and mortality worldwide.

Key messages

Well-balanced eating habits like traditional Japanese diets is important for suppressing cancer.
317Neighbourhood built and social environmental attributes associated with frailty among mid-to-older aged Australian adults
Authors: Abe Takumi , Sugiyama Takemi , Carver Alison , Turrell Gavin
Published: September 2021

Background

Little is known about to what extent neighbourhood built and social environmental factors are associated with frailty among community-dwelling mid-to-older aged adults.

Methods

Participants of our cross-sectional study were adults aged 50-74 years residing in Brisbane, Australia. Frailty was assessed by a frailty index (FI), consisting of 32 items. Five built environmental attributes (population density, density of 4-way intersections, area of retail land, area of park land, and area of land for recreational facilities) and three social environmental attributes (safety, cohesion, and socio-economic status [SES]) were included. We performed multilevel logistic regression analysis to examine the associations between those attributes and frailty.

Results

Of 4,176 eligible participants (56.8% women), we found that 437 (10.5%) were frail (FI ≥ 0.35). After adjusting for potential confounders, one standard deviation (SD) increment in intersection density and retail land area was associated 26% (95%CI: 1.12, 1.41) and 18% (95%CI: 1.07, 1.30) higher odds of being frail, respectively. One SD increment in safety and area-level SES was associated with 24% (95%CI: 0.69, 0.84) and 30% (95%CI: 0.62, 0.79) lower odds of being frail.

Conclusions

This study found that mid-to-older aged adults with frailty are more likely to live in areas with higher intersection density, greater area of retail land, poorer safety, and higher levels of deprivation.

Key messages

There is spatial heterogeneity in the distribution of frailty. Future research should investigate behavioural mechanism for the distribution.
1284Food insecurity and mental health features and behaviours in adults from Portugal
Authors: Aguiar Ana , Maia Isabel , Pinto Marta , Duarte Raquel
Published: September 2021

Background

COVID-19 pandemic has been affecting population’s health and economies, in which food insecurity appears as important concern, particularly considering its associations with mental health and adverse behaviours. This study explored the relationship between food insecurity and mental health features and behaviours in adults from Portugal.

Methods

A cross-sectional study using data from an online survey was performed, including Portugal’s residents aged ≥18 years. Data on sociodemographics, behaviours, mental health features and food security status were collected. Food security status was evaluated with the United States Household Food Security Survey Module: Six-item Short Form. Chi-square test or Fisher's exact test, as appropriate, were used to explore the relationship between food security status and categorical variables.

Results

Food insecurity prevalence was 6.8%; showed to be significantly higher among less educated individuals (≤12 years of schooling) (p<0.001), those who were employed and remained since the beginning of the pandemic (p<0.001) and among those reporting need to be careful about expenses (p<0.001). Comparing to individuals who were food secure, food insecure participants were more likely to smoke (p=0.009), to report depressive symptoms (p<0.001) and anxiety (p<0.001), measured by the Hospital Anxiety and Depression Scale.

Conclusions

From the present study, it can be concluded that the COVID-19 pandemic can affect food security in different subpopulations.

Key messages

The findings of this study have several implications for health policy and reinforce the need for investment in contexts of populations vulnerable to food insecurity
707High levels of back disability,but not back pain,are associated with reduced physical activity in women
Authors: Alyousef Bothaina , Kazemi Zeinab , Cicuttini Flavia , Heritier Stephane , Wang Yuanyuan , Urquhart Donna
Published: September 2021

Background

Although clinical guidelines recommend physical activity for low back pain (LBP), our understanding of the physical activity undertaken by people with LBP is limited. We examined the amounts, intensities and types of physical activity performed by community-based women with different levels of pain and disability.

Methods

542 women were invited to participate. Physical activity was measured using the International Physical Activity Questionnaire, and LBP and disability were assessed using the Chronic Pain Grade Questionnaire. Participants were categorised into no/low or high pain intensity and disability groups.

Results

Women with high levels of back disability performed half the total physical activity of those with no/low levels of back disability (MET(hours/week): median(95%CI)=27.3(13.2-41.4) vs. 53.9(44.9-62.8),p=0.002), including less moderate (17.5(10.4-24.7) vs. 32.1(26.8-37.4),p<0.001) and domestic and gardening activity (14.4(7.2- 21.7) vs. 23.5(19.0-28.0), p = 0.02). Moreover, fewer women with high disability participated in vigorous (3(8.11%) vs. 134(32.0%),OR(95%CI)=0.17(0.04-0.75),p=0.02) and leisure activities (17(45.9%) vs. 294(70.2%),OR(95% CI)=0.44(0.21-0.94),p=0.03) compared to those with no/low disability. There were no differences in physical activity between women with no/low and high pain intensity (all p > 0.05).

Conclusions

High levels of back disability, but not back pain intensity, were associated with reduced physical activity, including less total activity, moderate and vigorous intense activity, and discretionary activity.

Key messages

These findings highlight the impact of high levels of disability on physical activity. Further work is needed to determine whether targeting these types and intensities of physical activity will help in reducing back disability.
85An Outbreak Of Foodborne Illness, Boamang-Kyerekrom D/A Primary School, Afigya Kwabre North District, Ghana
Authors: Laryea Eunice Baiden , Gyimah Charles Gyamfi
Published: September 2021

Background

On 6th June 2019, Afigya Kwabre North District Health Administration reported suspected foodborne illness involving primary school pupils at Boamang Kyerekrom D/A Primary School. Investigation was done to identify risk factors and implement control and preventive measures.

Methods

We conducted active case search and a retrospective cohort study. A case was a person from Boamang presenting with fever, diarrhea, or/and vomiting from 29th May to 7th June, 2019. Data was collected using questionnaires and review of health records. Environmental assessment was done. Stool sample of the last reported case and saltpeter used to prepare okro by food vendor was sent to the laboratory for investigation. All other diarrheal cases had being given antibiotics upon our arrival. Risk ratio was estimated to determine food with highest risk of causing illness.

Results

Of 312 people interviewed, 96 pupils were affected (AR = 30.8%). Common symptoms were fever, nausea, vomiting, abdominal pains and bloody diarrhea. There was no fatality. All cases were found to have eaten from a kenkey seller on the school premises. Risk ratio was highest (6.7) among those who took okro with the kenkey. Salmonella typhi was isolated in the stool of the last reported case. Cases were distributed across four (4) neighboring communities in Boamang.

Conclusions

Salmonella typhi was identified in the stool and the saltpeter. We recommend training of health staff on Integrated Disease Surveillance and Response (IDSR).

Key messages

Foodborne illness outbreak
1269Mental health among farmers and non-farmers at sugar cane industry: occupational health study in Peru
Authors: Bazalar-Palacios Janina , Bazo-Alvarez Juan Carlos , Flores Elaine
Published: September 2021

Background

We compare the prevalence rates of common mental disorders symptoms between farmers and non-farmers workers of the sugarcane industry and explore the role of relevant occupational factors.

Methods

We conducted a cross-sectional study with an occupational health & safety focus, describing the demographic and work characteristics of farmers and non-farmer of the sugar cane industry in San Jacinto, Peru. We identified mental disorders symptoms using a local validated version of the General Health Questionnaire (GHQ-12). We explored the association between symptoms of mental disorders, work conditions and known occupational risk factors. We explored the proposed association using negative binomial regression models to estimate Ratio of means (RM) and 95% confidence intervals (95% CI).

Results

We assessed 281 workers; 106 (37.7%) of respondents identified themselves as farm workers. The mean GHQ-12 score for farmers and non-farmers was 3.1 and 1.3 respectively. In the adjusted multivariate models mental disorders symptom counts among farmers was more than twice higher than those of non-farmers (RM: 2.11; 95% CI: 1.48-3.01). Also, having a low monthly salary (RM: 1.39; 95% CI: 1.00-1.92), and additional working hours per week (RM: 1.02; 95% CI: 1.00-1.03) were associated with higher counts of mental disorders symptoms.

Conclusions

Our Findings highlight the importance of including mental health within occupational programs and early interventions tailored to this target group.

Key messages

Occupational hazard; Mental disorders; Sugarcane work, Farmers.
736Low Birth weight in new born, anaemia in pregnancy in Fluoride endemic areas of Rajasthan
Authors: Bhardwaj Pankaj , Saxena Deepak , Joshi Nitin , Mantri Neha , Suthar Praveen
Published: September 2021

Background

Rajasthan has been documenting severe anaemia in pregnancy, resulting in low birth weight. Current study was planned to explore potential linkages between exposure to fluoride, anaemia in pregnancy and low birth weight in infant.

Methods

Antenatal mothers from one fluoride endemic district (FD) and one non-fluoride endemic district (NFD) of western Rajasthan were recruited and followed up till delivery. Data included socio-demographic, lifestyle, diet, medication history. Lab Investigations included Hb, Urinary Fluoride.

Results

Out of total 1401 women, mean age of women from FD were 23.87 (+ 3.8) yrs and from NFD were 25.53(+ 3.82) yrs. Mean fluoride values in the urine samples of pregnant females were found to be 2.06 (0.0 to 14.4 mg/L) in FD and 1.43 (0.00 to 12.7 mg/L) in NFD. Mean fluoride values in water samples were 0.72 (0.0 to 3.80 mg/L) in FD and 0.21 (0.0 to 2.69 mg/L) in NFD. Mean weight of newborn from FD were 2.92 (+ 0.47) yrs and from NFD were 2.94 (+ 0.56) kg. 22% Newborn in FD and 18% in NFD had low birth weight.

Conclusions

Infants born in Fluoride endemic area have lower birth weight as compared to non-Fluoride endemic area. Antenatal women in Fluoride endemic areas are more anaemic.

Key messages

Fluoride endemicity is an important factor to be considered while addressing Anaemia in pregnancy and Low Birth Weight Babies in Western Rajasthan, India.
1056Maternal dyslipidaemia is associated with shorter gestational length in a UK cohort of 7440 pregnancies
Authors: Birchenall Katherine
Published: September 2021

Background

Mechanisms for human labour are unknown because of difficulties in human pregnancy experimentation, limiting our ability to prevent preterm birth. Maternal metabolism is potentially involved. This study aimed to explore associations of multiple maternal metabolic traits with gestational age at delivery (GA).

Methods

Women with singleton pregnancies recruited to the Born in Bradford cohort study were included. A total of 157 maternal blood metabolites sampled between 26-28 weeks were measured using high-throughput NMR metabolomics. Associations between each metabolite and GA was modelled using linear (GA continuous) and logistic (GA binary) regressions; adjusted for age, BMI, ethnicity, socioeconomical status, alcohol, smoking, parity, pre-existing and gestational diabetes and hypertension, pre-eclampsia, and labour onset.

Results

The complete case sample included 7440 pregnancies (12308 eligible; 4540 had missing data). 1SD increases in large and very large HDLs were associated with longer mean GAs of 0.5-1 day, including 1SD increased HDL mean diameter associated with +0.5 day mean GA (95%CI:0.2to0.8;p=9.1E-4). 1SD increases in VLDLs and LDLs were associated with shorter mean GAs of 0.5-1 day, including 1SD increase in large VLDL associated with -0.7 days difference in GA (95%CI:-1.021to-0.465;p=2.299E-07).

Conclusions

Our findings suggest for the first time that maternal dyslipidaemia is related to differences in GA even after adjusting for multiple key confounders. Further studies are needed to clarify whether lipoprotein metabolism is causally involved in human labour.

Key messages

Human labour may involve pathways related to lipoprotein metabolism.
960Dietary intakes of patients with first Acute Coronary Syndrome: the MENZACS study
Authors: Bradbury Kathryn , Choi Yeunhyang , Fyfe Christie , Poppe Katrina , Rolleston Anna , Korohina Erina , Mehta Suneela , Troughton Richard , Cameron Vicky , Porter Graeme , Kerr Andrew , Nunn Chris , Devlin Gerald , Doughty Rob , Legget Malcolm
Published: September 2021

Background

In New Zealand (NZ) approximately 10,000 people experience an acute coronary syndrome (ACS) annually. Little is known about the diets of people who present with first ACS.

Methods

The Multi-Ethnic NZ study of Acute Coronary Syndromes (MENZACS) is a multi-centre, longitudinal cohort study of patients with first-time ACS. At baseline, patients complete a validated short food frequency questionnaire (FFQ) asking about dietary intakes in the 12 months preceding their event. Participants are followed up for rehospitalisation and mortality.

Results

Here we present the dietary intakes of the 2,015 participants enrolled into MENZACS. We excluded 90 participants who did not start the FFQ and 42 participants who had extreme energy intakes. For men (n = 1489), the median energy intake was 8637 kJ, and the median percentage of energy from carbohydrate, protein, fat, and saturated fat were 40.3%, 17.9%, 34.7% and 17.8%, respectively. For women (n = 394), the median energy intake was 7499 kJ, and the median percentage of energy from carbohydrate, protein, fat and saturated fat were 40.3%, 18.4%, 35.6%, and 18.0%, respectively.

Conclusions

Both men and women reported high saturated fat intakes in the year preceding their first ACS. Future work will examine dietary predictors of rehospitalisation and mortality, as well as analyse baseline blood samples for Lipoprotein(a) and lipidomics.

Key messages

Patients in hospital with first time ACS are able to complete a short food frequency questionnaire, with little missing data.
1254Comorbidity of atopic diseases and gastroesophageal reflux in adults: a co-twin control study
Authors: Brew Bronwyn , Almqvist Catarina , Lundholm Cecilia , Andreasson Anna , Lehto Kelli , Talley Nicholas , Gong Tong
Published: September 2021

Background

Gastroesophageal reflux disease (GERD) is the most common non-allergic comorbidity in adults with asthma, however comorbidity with other atopic diseases such as eczema and hayfever is unclear. The objective was to assess the comorbidity of GERD with atopic diseases in adults, and to investigate possible mechanisms including genetic and affective factors.

Methods

A co-twin control study harnessing 46 583 adult Swedish twins. Questionnaires on health status were linked to national patient and prescribed drug register data. Within twin-pair comparisons were made between unpaired, monozygotic (MZ) and dizygotic (DZ) twins to assess common genetic liability. Affective traits (depression, anxiety and neuroticism) were added to models to assess their role in comorbidity.

Results

The risk of GERD in those with asthma was OR1.52 (95% CI 1.38, 1.68); hayfever OR1.22 (95%CI 1.12, 1.34); and eczema OR1.23 (95%CI 1.10, 1.38). Within twin-pair associations attenuated in decreasing order of shared genetics for all atopic diseases e.g. self-report asthma with GERD: DZ twins adjOR1.41 (95%CI 0.96, 2.08), MZ twins adjOR1.24 (95%CI 0.82, 1.87). Adjusting for affective traits only slightly attenuated the comorbidity associations.

Conclusions

GERD is a common comorbidity in adults with asthma, hayfever and/or eczema. We found evidence for shared genetic factors but not for affective traits.

Key messages

GERD is a common comorbidity not only in adults with asthma, but also in adults with eczema or hayfever. Twin research has revealed evidence for a common genetic liability to explain comorbidity.
872Novel approach to estimating sex differences unconfounded by familial factors from studying male-female twin pairs
Authors: Calais-Ferreira Lucas , Mendonça Everton , Li Shuai , Barreto Marcos , Hickey Martha , Dite Gillian , Ferreira Paulo , Scurrah Katrina , Hopper John
Published: September 2021

Focus of Presentation

Males and females differ substantially in their exposures and outcomes across the life-course. Previous research into sex differences has been limited by an inability to account for inter-individual differences in genetic factors and in their early-life environment. Studying within male-female twin pair differences offers a unique opportunity to address these weaknesses that has not yet been exploited.

Findings

We studied linked health administrative data for 28,054 newborn Brazilian male-female twin pairs. Using random-effects logistic regression, we found that males had 1.61 (95% CI: 1.38– 1.90, P<0.001) times higher risk of early neonatal mortality (first 6 days of life) compared with their female co-twins, after adjusting empirically for birthweight and matching for gestational age and, by design, for unmeasured familial factors including on average 50% of genetic factors.

From analysing within-pair differences in genome-wide DNA methylation in blood samples for 55 Australian adolescent male-female twin pairs, we found that 1,227 DNA methylation sites were more methylated in females while only 157 sites were more methylated in males (P<10-6). We also found weak evidence suggesting that males have older DNA-methylation-based biological age than females (P=0.2).

Conclusions/Implications

Sex differences not explained by familial confounders exist for neonatal mortality in newborns and for DNA methylation in blood during adolescence.

Key messages

Analysing the within-pair differences of male-female twin pairs brings novel and important strengths to the study of sex differences, helping mitigate bias from uncontrolled familial confounding caused by genetic and environmental factors.
146Mendelian randomisation for mediation analysis: current methods and challenges for implementation
Authors: Carter Alice , Sanderson Eleanor , Hammerton Gemma , Richmond Rebecca , Smith George Davey , Heron Jon , Taylor Amy , Davies Neil , Howe Laura
Published: September 2021

Background

Mendelian randomisation uses genetic variants randomly allocated at conception as instrumental variables for an exposure. Methodological advances allow for mediation analysis to be carried out using Mendelian randomisation using either multivariable Mendelian randomisation or two-step Mendelian randomisation.

Methods

We use simulations and an applied example to demonstrate when multivariable Mendelian randomisation and two-step Mendelian randomisation methods are valid and how they relate to traditional phenotypic regression-based approaches to mediation. We demonstrate how Mendelian randomisation methods can relax assumptions required for causal inference in phenotypic mediation, as well as which Mendelian randomisation specific assumptions are required. We illustrate our methods in data from UK Biobank, estimating the role of body mass index mediating the association between education and cardiovascular outcomes.

Results

Both multivariable Mendelian randomization and two-step Mendelian randomization are unbiased when estimating the total effect, direct effect, indirect effect and proportion mediated when both confounding, and measurement error are present. Multivariable Mendelian Randomization can be used when multiple mediators are to be investigated in a single model.

Conclusions

Mendelian randomisation provides an opportunity to improve causal inference in mediation analysis. Although Mendelian randomisation specific assumptions apply, such as no weak instrument bias and no pleiotropic pathways, strong phenotypic assumptions of no confounding and no measurement error can be relaxed.

Key messages

Mendelian randomisation offers an opportunity to address bias by unmeasured confounding, measurement error and reverse causality in mediation analysis.
1243Quantitative risk-benefit assessment of fish and seafood consumption scenarios to support recommendations
Authors: Carvalho Catarina , Correia Daniela , Severo Milton , Afonso Cláudia , Bandarra Narcisa M. , Gonçalves Susana , Lourenço Helena M. , Graça Dias M. , Oliveira Luísa , Nabais Pedro , Carmona Paulo , Monteiro Sarogini , Borges Marta , Lopes Carla , Torres Duarte
Published: September 2021

Background

Fish/seafood consumption has health benefits, namely due to its omega-3 fatty acids levels and risks due to methylmercury contamination. This study aims to quantify the health impact of hypothetical scenarios of fish/seafood consumption through a risk-benefit assessment and provide support for recommendations, using Portuguese food consumption data.

Methods

We used data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n = 5811) to estimate the mean exposure to methylmercury and EPA+DHA in the current and alternative scenarios. Alternative scenarios were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (predatory vs low-mercury species) or its frequency (1-7x/week). The overall scenarios’ impact was quantified using Disability-Adjusted Life Years (DALYs).

Results

About 14% of the Portuguese population exceeds the methylmercury tolerable weekly intake, and this prevalence is higher among small children (36.6%). Nevertheless, if the fish/seafood consumption increased to once a day, ≈11450 DALYs could be prevented each year. However, such a scenario would result in higher risk for pregnant women (1398 extra DALYs). Moreover, excluding predatory species consumption resulted in small but significant health gains (-1078 DALYs).

Conclusions

For the general population, the maximum health gains are obtained by consuming fish/seafood up to 7x/week, but among children and pregnant women, the frequency should be limited to 3-5x/week. All population should preferably choose non-predatory species.

Key messages

Daily fish consumption results in the highest overall populational health gain, but children and pregnant women need to limit it to 3-5x/week, due to methylmercury exposure.
1375Age-standardization to world population and under-estimation of oral cancer burden
Authors: Chaudhry Kishore , Bollu Prashanti
Published: September 2021

Background

Age-standardization is common for adjustment of unequal population in different ages as it can influence cancer incidence. However, for planning healthcare services (including screening), one needs absolute magnitude since everyone needs intervention. This study assessed the effect of age-standardization on understanding the global differentials in magnitude of oral cancer.

Methods

Data on cancer incidence rates of oral cancers for 2008-2012, was obtained from the website of international agency for research on cancer for all 334 population-based cancer registries. Scatter plots were prepared between age-standardized and crude incidence rates to assess the ratio between them according to proportion of old people for all countries. Areas with high occurrence of oral cancer were identified.

Results

The ratio between age-standardized and crude incidence rate was >1 in countries with high proportion of older population (high-development-index countries), indicating an artificial widening of gap between incidence rates between countries due to age-standardization. Six areas had higher crude incidence rate among men than India. Based on the published estimates, the per-unit-population burden in Europe was 6.3% higher than India, while in USA it was merely 12.5% lower than India.

Conclusions

The perception of low burden of oral cancer in high-economy countries is artificial, brought about by common practice of age-standardization.

Key messages

Organization of oral cancer screening activities by countries with resources and expertise will provide much needed knowledge on its natural history and efficacy of control strategies.
1386Ethnic differences in lifestyle interventions for diabetes prevention: a systematic review and meta-analysis
Authors: Chen Mingling , Ukke Gebresilasea , Sood Surbhi , Bennett Christie , Khomami Mahnaz , Moran Lisa , Harrison Cheryce , Absetz Pilvikki , Teede Helena , Lim Siew
Published: September 2021

Background

The risk of type 2 diabetes varies by ethnicity, but ethnic differences in response to lifestyle interventions for diabetes prevention remain unclear. This systematic review and meta-analysis aimed to assess differences in the effects of lifestyle interventions on diabetes incidence, glycemic outcomes and anthropometric measures between ethnic groups.

Methods

MEDLINE, EMBASE, Pubmed, CINAHL, PsycInfo and EBM Reviews were searched (to June 2020) with no language restriction for randomized and non-randomized controlled trials on lifestyle interventions involving diet and/or physical activity in adults at risk of type 2 diabetes. Ethnicity was categorized into European, South Asian, Other Asian, Middle Eastern, Latin American and African groups based on the World Bank regions. Risk ratios for diabetes incidence and mean differences for glycemic outcomes (fasting glucose, 2-h glucose, HbA1c) and anthropometric measures (weight, BMI, waist circumference) were pooled using random-effects meta-analysis.

Results

Sixty articles representing 43 studies (18,691 participants) were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in diabetes incidence, glycemic outcomes and anthropometric measures compared with controls (all P<0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI and waist circumference (all P<0.05) but not for diabetes incidence, fasting glucose and HbA1c (all P>0.05).

Conclusions

Lifestyle interventions are similarly effective in reducing diabetes incidence, fasting glucose and HbA1c for all ethnic groups, however, 2-h glucose and anthropometric outcomes should be optimized in certain ethnic groups.

Key messages

Lifestyle intervention is likely effective in preventing the progression to type 2 diabetes equally across all ethnic groups.
1235Household air pollution and lung cancer mortality among never-smokers: findings from the China Kadoorie Biobank
Authors: Cheng Elvin , Chan Ka Hung , Weber Marianne , Steinberg Julia , Canfell Karen , Yu Xue Qin
Published: September 2021

Background

Household air pollution (HAP) has been classified as a major risk factor for lung cancer (LC) among never-smokers, however, evidence is largely from case-control studies. Using the prospective cohort China Kadoorie Biobank (CKB), we investigated the association of HAP with LC death among never-smokers.

Methods

The CKB, a large-scale cohort study, recruited 512,715 adults aged 30–79 years from ten regions in China during 2004-2008. Self-reported never-smoking participants were followed up to 31/12/2016 with linkage to mortality data. Total duration of HAP exposure was calculated from self-reported solid fuel use in domestic cooking and slow-burning stoves in participants’ three most recent residences, and self-reported coal-smoky home in winter during their lifetime. Hazard ratios (HR) and 95% confidence intervals (CI) of LC death associated with HAP exposure were estimated using Cox regression, adjusting for key confounders including several demographic, environmental and lifestyle factors.

Results

There were 979 LC deaths among 323,794 never-smokers without prior cancer during a median follow-up of 10.2 years. There was a log-linear positive association between HAP exposure and LC death (p-trend=0.0034), with 4% increased risk per 5-year longer exposure (HR = 1.04; 95% CI 1.01-1.06); and participants with 40.1-50.0 years of exposure had the highest risk compared to the never-exposed (HR = 1.53; 95% CI 1.13-2.07).

Conclusions

This study provides new prospective evidence that HAP exposure is associated with LC death among Chinese never-smokers, and strengthens the previous evidence largely based on case-control studies.

Key messages

This study supports HAP as an important risk factor for LC development among never-smokers.
260Smoking, body mass index, and risk of vasomotor symptoms: a pooled analysis of eight studies
Authors: Chung Hsin-Fang , Anderson Debra , Mishra Gita
Published: September 2021

Background

Vasomotor symptoms (VMS), including hot flushes and night sweats, are linked with adverse health outcomes. This study investigated the associations between smoking, body mass index (BMI), and their joint effects with the risk of VMS.

Methods

We pooled individual-level data on 21,460 midlife women from eight cohort studies in the InterLACE consortium. Frequency or severity of VMS were self-reported and categorised into four levels (from none to frequent/severe). Multinomial logistic regression models were used to estimate relative risk ratios (RRRs) and 95%CIs adjusted for within-study correlation and covariates.

Results

Nearly 60% of the women experienced some degree of VMS; 30% were overweight, 21% obese, and 17% current smokers. We found that smoking more cigarettes with longer duration and earlier initiation and being overweight or obese were all associated with more frequent/severe VMS. Never smokers who were obese had a 1.5-fold increased risk of frequent/severe VMS (RRR 1.52, 95%CI 1.35-1.73), compared with never smokers who were of normal-weight. Smoking strengthened the association because the risk of frequent/severe VMS was much greater among smokers who were obese (RRR 3.02, 95%CI 2.41-3.78). However, women who quit smoking before age 40 years had a similar level of risk as never smokers.

Conclusions

Cigarette smoking and overweight/obesity substantially increased women’s risk of frequent or severe VMS in a dose-response manner, and smoking intensified the effect of obesity.

Key messages

Quitting smoking before age 40 years and maintaining a normal weight before the menopausal transition may mitigate the excess risk of VMS in midlife.
1517The effect of pregnancy on cardiovascular health in early adulthood: a difference in difference analysis
Authors: Clayton Gemma , Howe Laura , Parks Chloe , Leyland Kirsten , Hughes Alun , Fraser Abigail
Published: September 2021

Background

Pregnancy causes extreme cardiometabolic changes, yet evidence of its long-term cardiovascular effects is limited. Our aim was to estimate the causal effect of pregnancy on cardiovascular health.

Methods

We used a difference-in-difference (DiD) model to estimate the causal effect of pregnancy on multiple cardiovascular health measures (N = 445–1822 for cardiac echocardiography, blood based markers, blood pressure (BP) and anthropometry) in female participants in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18-25 years. We differentiated between live birth and miscarriage/termination. Briefly, DiD assumes baseline differences in the outcome reflect confounding, that the rate of change in the outcome is similar in exposed and unexposed prior to the exposure, and that no new confounding was introduced after baseline. Any DiD at follow up is then attributed to the exposure.

Results

289 women had a pregnancy between ages 18-25 (15%). We found no effect of pregnancy on various echocardiography measures including left ventricular mass index. When accounting for changes in BMI, HDL-c and systolic BP at age 25 was -0.22mmol/L (95%CI:-0.28, -0.15) and -1.37mmHg (95%CI:-3.25, 0.52) lower, respectively, in women who had a live birth compared to no pregnancy. BMI, fat mass, and lean mass were higher in women who had a live birth versus no pregnancy.

Conclusions

Findings are consistent with limited existing evidence of BP lowering and lipid increasing effects of pregnancy. Future studies should investigate underlying mechanisms.

Key messages

Pregnancy results in a reduction in systolic BP and an adverse effect on HDL-c levels.
899Stepping up: identifying small-area variation in diabetes-related lower limb amputations
Authors: Cramb Doctor Susanna , Lazzarini Doctor Peter , Barnett Adrian , Daniel Mark
Published: September 2021

Background

Diabetes-related foot disease is the leading cause of lower limb amputations in Queensland. Amputations can be either minor (below the ankle joint) or major (above the ankle joint). Minor amputations may be performed to prevent major amputations prophylactically, but how these forms of amputations interrelate, and where their interrelationships are weakest and strongest, is unknown. Knowledge of small-area variation in interrelations between minor and major amputations is relevant to prevention and improved management of foot disease.

Methods

Data on lower limb amputations performed between 2014 and 2018 on patients aged 20+ years with diabetes were obtained from the Queensland Hospital Admitted Patient Data Collection. Rates were calculated using the number of people, rather than the number of amputation procedures. A Bayesian hierarchical spatial multivariate model was used to examine patterns over 516 populated statistical areas 2 in Queensland.

Results

During 2014 to 2018, 3,548 Queenslanders had at least one minor amputation, and 1,114 had at least one major amputation. Modelled amputation rates varied markedly across the State (standardised morbidity ratio (SMR) IQR: 0.67 to 1.22), with areas in far north Queensland having extremely high rates. There was consistently high area-level correlation between minor and major amputation rates. The highest SMRs for both minor and major amputations were in the Northern Peninsula.

Conclusions

Elevated rates of minor and major amputations in areas in Queensland, most noticeably the far north, indicate an urgent need for greater support for people with diabetes-related foot disease.

Key messages

Text: Large differences in minor and major amputation rates across Queensland indicate that certain regions require greater assistance in managing diabetes-related foot disease.
1489Hearing loss before and after COVID-19 pandemic
Authors: Daimaru Graduate student Kaori , Wagatsuma Yukiko
Published: September 2021

Background

Hearing loss is a major issue in public health. It is caused by infections, loud sounds, chronic diseases, and aging. COVID-19 pandemic occurred in 2020 dramatically changed people’s lifestyle. People stay at home, more frequently use online materials and communication, thus may use an earphone continuously. This study aimed to examine whether COVID-19 pandemic has an impact on hearing ability in Japan.

Methods

The persons who attended annual health check-ups in a regional examination center in 2019 were compared to those attended in 2020. The study participants were taken an informed written consent. Hearing loss was defined as hearing threshold of > 30 dB at 1 kHz and 4 kHz in either ear with pure-tone air-conduction audiometry. The rates of hearing loss were compared with the adjustment of age and sex. Two-sided p value <0.05 was considered statistically significant.

Results

Among 3351 participants in 2019, and 3762 participants in 2020, males were 57.5% and 56.2%, median age was 48.0 and 48.5 years, respectively. Overall rate of hearing loss was 13.7% and 16.2% in 2019 and 2020, respectively. After controlling with age and sex, the rate of hearing loss showed significant increase in 2020 (p < 0.05). The increase was observed in both age groups of 18-49 and 50-70 years (p<0.05).

Conclusions

This study showed the prevalence of hearing loss was increased across ages after COVID-19 pandemic.

Key messages

Hearing ability may have been affected by lifestyle changes due to COVID-19 pandemic.
1540Mental health of Australian women before and during the COVID-19 pandemic
Authors: Dawadi Shrinkhala , Meehan Edward , Boyle Jacqueline , Enticott Joanne , Lim Siew
Published: September 2021

Background

The COVID-19 pandemic is associated with increased psychological distress in Australia and globally. Few studies have examined distress in women, a group vulnerable to experiencing increased financial and child-care stressors during the pandemic. Such epidemiological benchmark data is essential for population monitoring, and can inform policy by highlighting groups at increased risk of mental health burdens.

Methods

Analysis of women aged 18-50 from a nationally representative survey collected in October 2020 (n = 1005) and the 2017-18 National Health Survey (n = 4267). Trends in the prevalence of very high scores on the Kessler-10, a measure of psychological distress capturing symptoms of affective and anxiety disorders, were compared across the surveys and by sociodemographic characteristics (age, education, socioeconomic status, income, family type and employment change).

Results

Rates of very high psychological distress were 4.6% in 2017-18 (95% CI = 3.8%-5.4%) to 19.3% in 2020 (95% CI = 16.9%-21.8%), and were greater in 2020 across all sociodemographic subgroups. In 2020, rates were highest in women who experienced employment change (29.8%, 95% CI = 24.1%-35.6%), earned $0-$49,000 annually (25.7, 95% CI = 18.5%-32.9%), and were single with children (24.8%, 95% CI = 16.3%-33.2%).

Conclusions

Psychological distress has increased in Australian women during the pandemic, especially for those experiencing employment change, with lower incomes, or who are single parents. Findings will be discussed in the conjunction with extant social policies and access to mental health support.

Key messages

The rate of very high psychological distress has increased fourfold in Australian women during the pandemic.
1265Association between fruit and vegetable intake and depressive symptoms over 15 years in young women
Authors: Dharmayani Putu Novi Arfirsta , Mihrshahi Seema , Mishra Gita
Published: September 2021

Background

The role of higher intake of fruit and vegetables has been of particular interest as a novel approach to reduce the risk of depressive symptoms. This study examined the association between fruit and vegetable intake and depressive symptoms in the 1973-78 cohort in the Australian Longitudinal Study on Women’s Health.

Methods

A total of 4241 women with a mean age of 27.6 (SD 1.5) years were followed up at five surveys over 15 years starting from 2003. The Center for Epidemiologic Studies Depression-10 scale with a cut off > 10 indicated depressive symptoms. Fruit and vegetable intake was assessed using short questions. Multiple imputations with generalised estimating equations models were performed to estimate odds ratio of depressive symptoms according to fruit and vegetable intake.

Results

Fruit and vegetables were cross-sectionally associated with reduced odds of depressive symptoms. In longitudinal analysis, higher intake of fruit (> 4 servings) and vegetable (> 5 servings) was consistently associated with a reduced odds of depressive symptoms, with a 25% reduced odds (OR 0.75; 95% CI 0.57, 0.98, p = 0.032) and a 19% reduced odds (OR 0.81; 95% CI 0.70, 0.94, p = 0.008) respectively.

Conclusions

These findings suggest that a higher intake of fruit and vegetables was associated with a lower risk of depression symptoms over 15 years from a population-based prospective study of Australian women.

Key messages

Increasing intake of fruit and vegetables in the younger population may be a promising approach to reducing the risk of depressive symptoms in the long run.
489Trends in method-specific suicide among Japanese adolescents in the past four decades
Authors: Dhungel Bibha , Thapa Anushka , Martinez-rives Noelia Lucia , Martin Pilar , Wada Koji , Gilmour Stuart
Published: September 2021

Background

In 2018 the overall suicide rate increased by 33% among students, as a part of a continued trend of rising suicide among adolescents. In 2015, the government of Japan aimed to reduce the overall suicide rate to 13 per 100,000 or less by 2025, but deaths among adolescents have been rising. This study analysed the trends in method-specific suicide among Japanese adolescents from 1979 to 2016 and compared suicide mortality rate in Japan with other OECD countries.

Methods

We obtained vital statistics data from the Japanese Ministry of Health, Labour and Welfare as well as the global health observatory of the WHO. Poisson regression analysis was performed separately by sex with year, age category, suicide method and a 1998 step variable as covariates.

Results

We found that hanging suicide rates among high school level boys are 12.15 times and girls are 6.17 times the rate of elementary school-aged children. The year 1998 saw a peak in suicide rates by hanging, which increased by more than 60% among both boys and girls. Japan is near the median of OECD suicide rates, with crude suicide mortality rates of 7.8 per 100,000 among 15–19-year-olds in 2016.

Conclusions

Suicide among adolescents has been rising during the last decades. Several factors related to the school and family environment, and mental health problems may have affected the adolescent suicide rate in Japan

Key messages

An urgent need is evident to address suicide among high school and university-aged adolescents.
1153Marital dissolution in later life: Change in health behaviours and outcomes following divorce and widowhood
Authors: Ding Melody , Gale Jo-Anne , Bauman Adrian , Phongsavan Philayrath , Nguyen Binh
Published: September 2021

Background

Marital dissolution, such as divorce and widowhood, are common life events with potentially important implications on health. Previous research has found that those who have divorced or widowed tended to have a higher risk of mortality, however, the mechanisms for the observed associations are not well understood. We aimed to examine the association of divorce and widowhood with subsequent changes in health-related lifestyles, psychological outcomes, and overall health and wellbeing within both immediate and longer terms.

Methods

We used data from the 45 and Up study collected at baseline (T1, 2006-09), first (T2, 2010) and second follow-up (T3, 2012-16). Martial status and health-related outcomes were self-reported at all three time-points using validated questionnaires. Nine outcomes were examined, including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/well-being (self-rated health and quality of life). Logistic regression and generalised estimating equations were conducted adjusted for sociodemographic characteristics.

Results

Of the 33184 participants who were married/co-habiting at T1, after 3.4 years, 2.9% became divorced and 2.4% widowed. Those who divorced had much higher odds of smoking, having poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for those who became widowed. After another 5 years of follow-up, however, the associations were much attenuated towards the null.

Conclusions

We found strong adverse short-term effects of marital dissolution on health outcomes, particularly within the psychological health domain. The effects, however, seemed to attenuate in the longer terms.