bluuebunny/crossref_metadata_2025 huggingface dataset:
937Rasch analysis of the Health Literacy Questionnaire in the Understanding Multiple Sclerosis online course cohort
Authors: Bessing Barnabas , Honan Cynthia A. , van der Mei Ingrid , Taylor Bruce. B , Claflin Suzi B.
Published: September 2021

Background

We have built a six-week free online course to improve multiple sclerosis (MS)-related knowledge, health literacy (HL), and resilience among members of the MS community and interested laypeople, entitled Understanding MS. To evaluate the effectiveness of the course, we require an appropriate tool to measure HL in this cohort.

Objective

To evaluate the psychometric properties of the multidimensional Health Literacy Questionnaire (HLQ) in a cohort of Understanding MS online course enrolees.

Methods

Participants who enrolled in the first two open enrolments of the Understanding MS online course completed the HLQ (n = 1182) in an online survey prior to beginning course materials. We used Rasch analysis to assess the measurement properties of the HLQ.

Results

The nine subscales of the HLQ each had a good fit with the Rasch model; they were unidimensional, had good internal consistency and reliability and no item bias or local dependency measurement gaps were identified for participants with low or high scores in each of the nine subscales, creating a ceiling effect, meaning that the HLQ cannot reliably measure change in HL over time for these participants. The HLQ is a reliable measurement tool to assess change in HL for people with low to moderate HL levels who have room to improve, which is our target group.

Conclusion

The HLQ is useful for assessing HL in this and similar cohorts, but the assessment of HL change should consider the limitations described above.

Key messages

The HLQ has excellent measurement properties and is appropriate for assessing HL
970Comparison of lab-and non-lab based absolute cardiovascular disease risk scores in rural India
Authors: Birhanu Mulugeta Molla , Evans Roger G. , Zengin Ayse , Riddell Michaela A , Kalyanram Kartik , Kartik Kamakshi , Suresh Oduru , Thomas Nihal , Srikanth Velandai K. , Thrift Amanda G.
Published: September 2021

Background

Over 75% of global cardiovascular (CVD) deaths occur in low-to-middle-income countries (LMICs).

In limited resource settings non-lab-based CVD risk algorithms could be as effective as lab-based algorithms in identifying high-risk groups. We aimed to compare the concordance between lab-and non-lab-based absolute CVD risk algorithms in a LMIC setting.

Methods

The study was conducted in the Rishi Valley, Andhra Pradesh, India. Over 8,000 participants were surveyed between 2012-2015. The 10-year absolute CVD risk score was computed and compared using lab-and-non-lab based Framingham and WHO algorithms.

Results

In participants aged 35-74 years, absolute CVD risk score increased with age, and was greater in men than women, for all risk assessment tools. Using the Framingham lab-based algorithm, 15.6% were categorized as high-risk while 14.5% were at high-risk using the non-lab-based algorithm. The non-lab-based Framingham risk score had close agreement and strong correlation with the lab-based Framingham risk score in women (90%, Spearman’s rho (rs)=0.81) and men (83%, rs=0.89). Similarly, the non-lab-based WHO risk score had close agreement and strong correlation with the lab-based WHO risk score in women (95%, rs=0.83) and men (92% rs=0.84). In both cases, agreement was better in women than men (P < 0.05 for a two-sample test of proportions).

Conclusions

The effectiveness of non-lab-based Framingham and WHO algorithms are comparable to that of lab-based algorithms in discriminating high-and low-risk groups. However, the performance of non-lab-based risk score is better among women than men.

Key messages

Non-lab-based CVD risk algorithms could be effective and resource-efficient in LMIC settings, particularly among women.
796Is Mindfulness a more effective intervention than Psychoeducation for reducing Bipolar Disorder-related symptoms of depression?
Authors: Bowe Steven , Foley Fiona , Fletcher Kathryn , Thomas Neil , Michalak Erin , Berk Lesley , Berk Michael , Cotton Sue , Engel Lidia , Johnson Sheri L. , Jones Steven , Kyrios Michael , Lapsley Sara , Mihalopoulos Cathrine , Perich Tania , Murray Greg
Published: September 2021

Background

The primary objective is to test the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments.

Methods

An NH&MRC funded international RCT to compare the effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants were recruited primarily via social media channels. Evaluations occurred at pre- and post- treatment, and at 3- and 6- months follow-up. A secondary outcome measure was BD-related symptoms (depression). A longitudinal analysis was conducted using random effects mixed models.

Results

Preliminary results suggest no change in mean QIDS_total over time (p = 0.891). Nor does there appear to be a difference in groups (B coeff= 0.47, 95%CI (-0.60, 1.55), p = 0.613) and no difference in intervention groups over time (p = 0.828).

Conclusions

The effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD does not appear to have been any more effective than a psychoeducation intervention for reducing depression.

Key messages

There may be no significant benefit from using a mindfulness based, online guided self-help intervention over a psychoeducation intervention to reduce the BD symptoms of depression in late stage Bipolar disorder.
1048Characteristics of ST-Elevation Myocardial Infarction (STEMI) patients in Asia Pacific: findings from the ASPECT collaboration
Authors: Chih HuiJun , Brennan Angela , Yeo KK , Chan Mark , Yan Bryan , Duffy Stephen , Nguyen Hoai , Loi Do Doan , Fong Alan , Reid Christopher ,   on behalf of the ASPECT collaborators
Published: September 2021

Background

The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration was established to better understand the characteristics of patients undergoing PCI and cardiac interventions across the Asia Pacific region, including STEMI. The aim of this study was to compare STEMI patient characteristics across Asia Pacific (AP) countries in order to understand regional differences.

Methods

Each site across Australia, Singapore, Malaysia, Vietnam and Hong Kong provided de-identified individual patient data. Comparison of characteristics by sites were performed using one-way ANOVA, Kruskal-Wallis or Chi-squared tests, using Stata 14.2.

Results

Of the 12,620 cases, there were more males (p < 0.001) and the average of patients’ age ranged from 55 (Malaysia) to 68 (Vietnam) years old. Family history of coronary artery disease was not common amongst Hong Kong (1%) and Singaporean (12%) patients, and most patients did not have history of congestive heart failure, peripheral vascular disease or coronary artery bypass grafting. History of dyslipidaemia varied significantly among patients in Malaysia (98%) and Vietnam (12%) (p < 0.001). About 37% of the Malaysian patients had previous myocardial infarction, which is greater than twice of other cohorts (p < 0.001). Most cohort had either normal or mild ejection fraction (EF) but 40% of the Singaporean patients had severely reduced EF (p < 0.001).

Conclusions

Patient characteristics varied significantly across AP countries. On-going analyses will focus on the impact of varying patient characteristics on clinical outcomes.

Key messages

As characteristics varied, prevention and procedural strategies need to be adapted carefully. Additional input from other AP countries will better inform these strategies.
838Thriving in adversity: positive child development despite early disadvantage in a whole-of-population data linkage study
Authors: Chittleborough Catherine , Brown Thomas , Schuch Helena , Kalamkarian Anna , Pilkington Rhiannon , Montgomerie Alicia , Mittinty Murthy , Lynch John
Published: September 2021

Background

Experiencing socioeconomic disadvantage, poor health, or child maltreatment in early life has negative effects on child development. However, we know little about children who have good developmental outcomes despite experiencing adversity.

Methods

This study used de-identified, linked government administrative data from the South Australian Early Childhood Data Project: specifically Australian Early Development Census (AEDC) data for all South Australian born children in their first year of school in 2009, 2012 and 2015 (n = 47,179) and their corresponding birth, perinatal, school enrolment, hospital admission, emergency department presentation, public housing and child protection data. Latent class analyses constructed multidimensional measures of socioeconomic, health, and maltreatment adversities experienced from birth to age 5.

Results

Overall, 49.8% (95% CI 49.2-50.4) of children were on track on all five AEDC domains, but this ranged from 53.7% among children who did not experience high levels of adversity to 13.5% among children with high levels of all three adversities.

Conclusions

Among children who experienced high levels of two or three early adversity types, approximately 1 in 5 were developmentally on track. Understanding characteristics of these children who thrive, against the odds, will help identify intervention opportunities to improve child development.

Key messages

Compared with children who did not experience high levels of adversity, each additional adversity reduced the likelihood of being developmentally on track by approximately 10% to 15%. Children experiencing socioeconomic or maltreatment adversity were less likely to be developmentally on track than children experiencing health adversity.
541A Nationwide Evaluation of International Standards and Commonly-used Growth Charts for Predicting Adverse Perinatal Outcomes
Authors: Choi Stephanie , Gordon Adrienne , Hilder Lisa , Henry Amanda , Hyett Jon A. , Brew Bronwyn K. , Joseph Farmey , Jorm Louisa , Chambers Georgina M
Published: September 2021

Background

Abnormal fetal growth is a risk factor for perinatal mortality and morbidity. There is considerable debate about the choice and performance of growth charts to classify newborns as small or large for gestational age (SGA and LGA) as a proxy for the at-risk infants. Several international charts have been proposed to be adopted worldwide. We aim to evaluate the performance of commonly-used growth charts (including international INTERGROWTH-21st-standards) for predicting adverse outcomes among SGA and LGA babies.

Methods

A population cohort of 2.4 million singleton births (24+0–40+6 weeks) delivered in Australia, 2004–2013. Performance was evaluated by prevalence, relative risk and diagnostic accuracy for adverse outcome based on AUC.

Results

There was wide variation in SGA and LGA classification across charts. For example, compared to other charts, the INTERGROWTH-21st-standards classified half of the number of term-SGA babies (prevalence: 3-4% vs. 7-10%) (<10th-centile) and double the number of LGA babies (prevalence: 24-25% vs. 8-18%) (>90th-centile), resulting in a smaller cohort of term-SGA at higher-risk of adverse outcome, and a larger LGA cohort with lower-risk of adverse outcome. All charts performed poorly for detecting adverse outcomes (AUC range for a composite outcome: 0.49-0.68) and across birthweight centiles.

Conclusions

Significant differences in the classification of newborns and the chart performance raises concerns about whether the INTERGROWTH-21st-standards are applicable to a multi-ethnic population such as Australia.

Key messages

Significant differences in the classification of newborns and the relatively poor predictive ability of growth charts means that over reliance on infant size alone may misclassify, and thus miss at-risk infants.
53Women with syphilis notification in pregnant women who lose their baby, belém/pa, 2017 and 2018
Authors: Costa Josué , Flores Rute Leila dos Reis , Silva Veronilce Borges da , Neves Eula Oliveira Santos das , Cruz Carlos Gustavo Paes Barreto da , Maciel Ana Maria Teixeira Rico , Purificação Ana Cláudia Santos
Published: September 2021

Background

Syphilis is a chronic systemic infectious disease that is subject to acute outbreaks and latency periods when left untreated. It is an infectious disease produced by a bacteria, Treponema pallidum, of predominantly sexual transmission. The inclusion of syphilis in pregnancy as a sexually transmitted infection with compulsory notification is justified by its high prevalence rate and high vertical transmission rate, which ranges from 30% to 100% without adequate treatment. Congenital syphilis is a result of the hematogenous spread of Treponema pallidum, an untreated or inadequately treated pregnant woman, through the placenta, which causes miscarriages or child and fetal deaths. Our objective was to draw an epidemiological profile of women, living in Belém / PA, notified by syphilis during pregnancy and who developed infant or fetal death in 2017 and 2018.

Methods

This is a descriptive epidemiological study. Two information systems were used, the Mortality Information System (MIS) and the Notification Record Information System (NRIS). At MIS, all child and fetal deaths of residents of Belém in 2017 and 2018 were selected. In NRIS, we selected all cases of pregnant women notified by syphilis in 2017 and 2018, also resident in the municipality. Subsequently, the two banks were compared to verify whether pregnant women notified for syphilis evolved with infant or fetal death. Data were analyzed according to age, race, education, gestational period, length of treatment of pregnant women, whether the partner was treated and the type of death of the children.

Results

We found 32 women with reports of syphilis in pregnant women, of whom 81% developed fetal death and 19% had infant death. 63% were between 20 and 29 years old, 88% were brown, 75% were in the third trimester of pregnancy when they were notified, 25% had incomplete elementary school and 25% had incomplete high school. 72% were treated with 7,200,000 IU of Penicillin G Benzathine. 59% of cases were not performed in the treatment of the partner.

Conclusions

Most of these women are young, poorly educated, and despite appropriate treatment, their partners have not been treated and may have been reinfected and passed on the infection to their children.

Key messages

Syphilis in pregnant women; Hild and fetal death
54Project to encourage mandatory reporting of public health diseases
Authors: Costa Josué , Flores Rute Leila dos Reis , Silva Veronilce Borges da , Neves Eula Oliveira Santos das , Cruz Carlos Gustavo Paes Barreto da , Maciel Ana Maria Teixeira Rico , Purificação Ana Cláudia Santos
Published: September 2021

Background

Compulsory notification means official communication to health authorities about the occurrence of a disease or health problem that can be made by any citizen or health professional in order to adopt relevant intervention measures. An early suspicion of any disease can prevent complications and even the death of a patient. When we talk about notifiable diseases, it can mean avoiding hundreds or even thousands of deaths. Thus, our goal is to encourage compulsory notification of diseases of interest to the health of the population.

Methods

This project plans to make available to all public and private health services in the municipality and to all levels of attention, table stickers and banners with case definitions of the most common diseases in our municipality and of interest to public health. These diseases are dengue and Chikungunya fever, acute Chagas disease, meningococcal disease, leptospirosis, measles and whooping cough. The table stickers will be distributed at the doctor and nursing office for consultation of health professionals during patient care. The banners will be displayed in common areas of health services.

Results

The project is still in the process of approval by the health department, but it is expected that there will be an increase in the number of notifications and a decrease in the number of cases notified later. Early suspicion and reporting means that the patient can receive appropriate treatment in a timely manner and which control measures can be used quickly to prevent outbreaks or epidemics.

Conclusions

This project is expected to be approved quickly by the health department and can be implemented in all public and private health services in the municipality. Believe that the benefits can be seen in a short period of time, because with the closest information from professionals and the population, the suspicion will be faster.

Key messages

Compulsory notification; Diseases
1447Gastric histopathology by Helicobacter pylori cagA status in Arctic Canada
Authors: Cromarty Taylor , Quilty Douglas , Assi Ali , Girgis Safwat , van Zanten Sander Veldhuyzen , Goodman Karen ,   CANHelp Working Group
Published: September 2021

Background

Our community-driven projects address concerns of Canadian Arctic Indigenous communities about Helicobacter pylori (Hp) infection, responsible for elevated gastric cancer mortality in the region. Community research partners wished to learn whether bacterial characteristics determine severity of Hp-related disease in their communities. We aimed to describe gastric histopathology by cagA genotype of Hp isolated from residents of 7 Indigenous communities in the Northwest Territories and Yukon.

Methods

Participants underwent gastroscopy with 5-6 biopsies taken for histopathological assessment and 2 biopsies taken for tissue culture during 2008-2017. We used multiple PCR reactions and DNA sequence analysis to classify Hp genotypes as cagA+ or cagA-. A single pathologist used the updated Sydney classification system to grade severity of 5 gastric pathology outcomes: Hp density; chronic gastritis; active gastritis; atrophy; and intestinal metaplasia. We estimated prevalence of each outcome with 95% confidence intervals (CI) by gastric subsite and cagA status.

Results

Of 262 Hp isolates assessed, 142 (54%) were cagA+. Prevalence of moderate-high Hp density, severe chronic gastritis, moderate-severe active gastritis, atrophy, and metaplasia were (%[CI]): respectively, 78[70-85], 44[36-53], 65[56-72], 55[46-63], 25[18-33] in cagA+ participants and 61[52-70], 35[27-44], 31[23-40], 32[23-41], 8[4-15] in cagA- participants. cagA+ participants had higher prevalence of all outcomes in antrum and corpus.

Conclusion

Hp-infected Indigenous residents of Arctic Canada who harbored cagA-positive strains had higher prevalence of more severe gastric pathology than those with cagA-negative strains.

Key messages

Community-driven research answers questions posed by those who bear the disease burden.
274Early adversity scale for schizophrenia (EAS-SZ) constructed and validated using linked register data
Authors: Di Prinzio Patsy , Björk Jonas , Morgan Vera
Published: September 2021

Background

A range of adversities have been implicated as risks for schizophrenia. Adversities often cluster, with synergistic impact, which may vary by age of exposure. We expand on current understanding, and propose a method for ranking combinations of adversities associated with risk of schizophrenia, to derive a risk prediction measure.

Methods

We used prospectively collected data for 430,000 children born 1980–2001 in Western Australia, and their parents. Follow up continued until 2015 using linked State registers, identifying 1,620 children with schizophrenia. Five domains of adversity exposure to age 10 were considered. Using Cox modeling of a 40% training data subset, we categorised adversity exposure by associated rates of schizophrenia. Firstly, for each domain separately, numerous constructs of adversity exposure were screened for independent association with schizophrenia. Those with p < =0.2 were combined, using augmented backwards elimination, to define a minimal domain set of jointly associated constructs. Combination was summarised as the linear predictor corresponding to the optimum Cox model. Secondly, these domain summaries were combined with each other to form a global Cox model, predictive of association with schizophrenia.

Harrell’s Concordance was calculated using a 30% assessment sample which did not overlap with our training sample. Prognostic categories were defined and tested.

Results

Harrell’s Concordance was 0.655. Dose response was observed.

Conclusions

Our scale combines many adversity measures into a single construct. It displays dose response and predicts association considerably above chance.

Key messages

EAS-SZ allows a range of adversity exposure profiles to be ranked according to association with schizophrenia.
777Teaching evidence-based medicine using authentic assessment the Whack-a-mole project
Authors: Diug Basia , Howard Bethany , Harvey Kenneth
Published: September 2021

Introduction

Authentic assessments facilitate student’s application of complex problem-solving skills and knowledge to real-world tasks. The whack-a-mole (WAM) project includes key critical thinking, biostatistics and epidemiology skills as well as elements of complexity and creativity skills that are particularly important when teaching evidence-based medicine to health professionals. Complementary and alternative medicines (CAMs) provide the current context as they are widely used in the Australian population making them an important subject amongst primary health care professional and policy makers.

Aim

To report student perceptions and learning after completion of the real-world authentic assessment WAM.

Methods

WAM required students to choose, document, investigate, identify, critically appraise and report on a complementary medication for sale in Australia. A total 464 students enrolled in a 3rd Biomedical Science capstone unit completed the WAM project report and video assessments in teams. Data on student perceptions was collected using an online questionnaire and analysed using SPSS 25 and NVIVO 11.

Results

The average overall mark for the WAM assessment was 52/60 (86%). 116 students (25%) completed the online questionnaire of which 92% of students indicated the whack-a-mole project changed their perceptions of complementary medicine and/or the regulation of goods and services in Australia. The majority of students found no (43%) or insufficient (55%) evidence to support product claims. These findings were supported by qualitative feedback.

Conclusion

Students applied the principles of EBM to the WAM project and in doing so altered their perceptions of CAM, regulation and scientific evidence.

Key messages

Authentic assessments play a key role in engaging student in real-world problem solving to advance their critical thinking and evidence-based medicine.
1046Physical activity and sitting time in relation to breast cancer risk: A Mendelian randomization analysis
Authors: Dixon-Suen Suzanne , Lewis Sarah J. , Martin Richard M. , Boyle Terry , Giles Graham G. , English Dallas R. , Milne Roger L. , Lynch Brigid M. ,   on behalf of the Breast Cancer Association Consortium
Published: September 2021

Background

Greater physical activity (PA) and less sitting time (ST) have been associated with lower breast cancer (BC) risk in observational studies, but causality is undetermined. Mendelian randomization (MR) investigates causality by using genotype to simulate randomized trials within observational data. A recent summary-data MR study assessed PA and BC by estrogen-receptor (ER) status. We aimed to examine PA and ST in relation to invasive BC risk overall and by molecular subtype.

Methods

We performed two-sample MR using individual-level Breast Cancer Association Consortium data from 125,684 women (69,869 cases), and summary-level UK Biobank genetic data for the exposure (n = 91,105). We used imputed single nucleotide polymorphisms (SNPs) previously associated (p < 5x10-8) with accelerometer-measured PA (n-SNPs=5) or ST (n = 6). We estimated odds ratios (OR) from inverse-variance weighted MR.

Results

Greater PA was associated with lower risk of BC (OR = 0.48;95%CI=0.30-0.78 per standard deviation [SD] in activity). Estimates were inverse for all subtypes, particularly ER + (OR=0.45; 95%CI=0.25-0.83), PR + (OR=0.43;95%CI=0.22-0.85), and HER2 + (OR = 0.48; 95%CI=0.26-0.89). Greater ST was associated with higher risk of hormone-receptor-negative tumours, particularly triple-negative (ER-/PR-/HER2-) (OR = 2.04; 95%CI=1.06-3.93 per SD in ST). Estimates overall and for most other subtypes were elevated but had wide CIs crossing null. Sensitivity analyses (weighted-median MR and MR-Egger) did not suggest strong pleiotropic effects for either exposure.

Conclusions

Greater PA and lower ST reduces risk of all breast cancers, and hormone-receptor negative tumours, respectively. More widespread adoption of active lifestyles will lower burden from the most common cancer in women.

Key messages

More active and less sedentary lifestyles reduce risk of breast cancer.
463Association of physical activity with obstructive sleep opena
Authors: Duan Miss Xueru ,   Murui Zheng,   Hai Deng,   Xudong Liu
Published: September 2021

Background

Obstructive sleep apnea (OSA) is the most common sleep disorder in clinical practice, which leads to impaired quality of life and is associated with adverse health outcomes. Due to limitations of continuous positive airway pressure (CPAP), the gold standard treatment for OSA, studies have recommended lifestyle interventions such as physical activity to prevent OSA. This study was to investigate the association of physical activity with OSA risk among adult Chinese.

Methods

9733 participants aged 35-74 years were selected from baseline survey of the Guangzhou Heart Study. OSA was ascertained by using Berlin Questionnaire and the physical activity, including leisure-time physical activity (LTPA), occupational activity and transport activity, was measured with modified Global Physical Activity Questionnaire. Principal component analysis was used to extract the patterns of LTPA with varimax orthogonal transformation. Odds ratio (OR) with 95% confidence interval (95% CI) was calculated by using logistic regression method.

Results

For all participants, LTPA (High vs. Inactive, OR: 0.81, 95% CI: 0.64 - 1.03), occupational activity (Vigorous vs. Retirement, OR:1.28, 95% CI: 0.93 - 1.75) and transport activity (High vs. Retirement, OR: 1.05, 95% CI: 0.69 - 1.60) were not associated with OSA risk after considering potential confounders. Any specific component of LTPA and two LTPA patterns were not associated with OSA risk, either. Stratified analysis yielded similar nonsignificant association of OSA risk with three dimensions of physical activity in both retirement group and non-retirement group.

Conclusion

This study found that three dimensions of physical activity, including LTPA, transport activity and occupational activity, were not associated with any risk of OSA. Future studies with longitudinal design are needed.

Key message

Physical activity may not decrease the risk of obstructive sleep apena.
649Personal history of keratinocyte carcinoma is a marker of inherited cancer risk: Mendelian randomization analyses
Authors: Dusingize Jean Claude , Olsen Catherine , An Jiyuan , Liyanage Upekha , Pandeya Nirmala , Law Matthew , Neale Rachel , Ong Jue-Sheng , MacGregor Stuart , Whiteman David
Published: September 2021

Background

A personal history of keratinocyte carcinoma (KC) has been reported as a risk factor for developing subsequent primary cutaneous and non-cutaneous malignancies. However most evidence to date stems from observational studies which are prone to bias, confounding and reverse causation. Our aim was to examine this association using different Mendelian randomization (MR) approaches.

Methods

We performed a one-sample MR analysis using individual-level data from the UK Biobank (n = 394,306). This analysis was then validated in an independent dataset in the QSkin cohort (n = 16,896). Using 64 independent genetic variants known to be associated with KC, we generated a polygenic risk score (PRS) for each participant in the UK Biobank and the QSkin cohort. We then performed two-sample MR analyses using genome-wide association study (GWAS) summary statistics. We tested the association between genetically predicted KC and risk of subsequent cancer using logistic regression.

Results

Results from one-sample MR analyses in the UK Biobank indicated that a personal history of KC was significantly associated with cancer overall (excluding melanoma) (OR: 1.15, 95% CI: 1.10-1.20, per doubling the prevalence of KC). The results from the two-sample MR corroborate the findings from the one-sample MR, although the risk estimate was lower (OR: 1.05, 95% CI: 1.03-1.07).

Conclusions

Our MR analyses suggest that genetically predicted KC is a risk factor for developing subsequent primary malignancies.

Key messages

A personal history of KC may serve as a proxy marker of inherited cancer risk.
1198The gendered associations between poverty, marital status, and mental health in older Australians
Authors: Ervin Jennifer , Milner Allison , Kavanagh Anne , King Tania
Published: September 2021

Background

Compared to men, older women have poorer mental health and are more vulnerable to poverty. Few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health among this group.

Methods

Drawing on 17 waves of the Housing Income and Labour Dynamics in Australia survey, fixed-effects regression analysis was utilised to examine associations between: (1) relative poverty (<50% median household income) and mental health (MHI-5); (2) marital status and poverty, among Australians aged 65+years. Effect measure modification (EMM) of the association between relative poverty and mental health by marital status was also assessed.

Results

Relative poverty was associated with poorer mental health among women (−0.62, 95%CI−1.06,−0.18), but not men. Being divorced/separated was associated with increased odds of relative poverty for women (OR 3.93, 95%CI 2.54,6.06) but not men, and widowhood was associated with relative poverty in women (OR 4.23, 95%CI 3.37,5.29), and men (OR 2.22, 95%CI 1.62,3.05). There was no evidence of EMM of the relationship between relative poverty and mental health by marital status for either gender.

Conclusions

This study provides evidence that relative poverty is a major determinant of mental health in older Australian women. Addressing gender inequities in lifetime savings, as well as in division of acquired wealth post marital loss, may mitigate these disparities.

Key messages

A gendered double burden of mental health issues and poverty exists for older Australian women, requiring urgent policy attention.
1019Socioeconomic inequities in 5-year weight trajectories in association with baseline weight-related perceptions: a longitudinal study
Authors: Feng Xiaoqi , Wilson Andrew
Published: September 2021

Background

Recognition of overweight may be a necessary pre-cursor for weight-reduction, but some suggest under-perceiving overweight may be protective against obesity. Differential responses may occur across socioeconomic strata.

Methods

Five-year body mass index (BMI) trajectories were examined using multilevel models of 8174 participants stratified by gender, neighbourhood socioeconomic circumstances, baseline BMI and perceived weight status, adjusting for potential confounders.

Results

At baseline, weight-related dissatisfaction and perceived overweight were associated with higher mean BMI, regardless of whether people were classified as ‘normal’ or overweight by WHO criteria. Mean BMI did not decrease among people classified as overweight who perceived themselves as overweight, or expressed weight-related dissatisfaction. Among those with ‘normal’ BMI at baseline but dissatisfied with their weight, mean BMI increased disproportionately among people in disadvantaged areas. Mean BMI also rose disproportionately for people in disadvantaged areas among those feeling overweight, despite having a ‘normal’ BMI, compared to people with the same over-perception but living in affluent areas.

Conclusions

No evidence was found to suggest accurate recognition of overweight or expressing weight-related dissatisfaction leads to a lower BMI. However, there was evidence of an increase in mean BMI among people who felt dissatisfied with, or over-perceived their ‘normal’ weight, especially in socioeconomically disadvantaged areas.

Key messages

Correction of under-perceptions may not drive weight loss, but circumstances contributing to over-perception and dissatisfaction with weight status may contribute to increased weight gain and exacerbate socioeconomic inequities in BMI.
1076Spatial modelling on maternal and child health: a scoping review
Authors: Ferreira Leonardo , Blumenberg Cauane , Hartwig Fernando , Barros Aluisio
Published: September 2021

Background

The Sustainable Development Goals brought attention to the lack of geographically disaggregated data in low- and middle-income (LMIC) countries as national health surveys are generally not designed to provide estimates beyond the first administrative level. Advances on small area estimation methods have allowed for more granular estimates which support targeting and implementation of local health interventions. This study aims to summarize literature on the advances in spatial modelling of reproductive, maternal, newborn and child health (RMNCH).

Methods

We carried out a comprehensive literature search in five databases to identify studies that: 1) performed small area estimation; 2) were carried out in LMIC settings; 2) focused on RMNCH outcomes; 3) were based on national health surveys. Studies modelling travel time were not considered.

Results

We included 70 out of 4266 studies. The state-of-art approach to small area estimation has been through a Bayesian framework with INLA for administrative level or up to 5x5 km estimates. Malaria and child mortality outcomes are predominant, closely followed by anthropometry, vaccination and contraceptives use.

Conclusions

Spatial modelling has become a suitable approach for local estimates where data at finer resolutions is not available. However, there is not a consensus on how to report and interpret uncertainties.

Key messages

Local estimates are essential to identify and act on the most disadvantaged areas. Properly communicating uncertainty is a big challenge for researchers and they must accompany estimates to avoid misinterpretation.
372Social Isolation, Social Support and Loneliness as independent interconnected concepts
Authors: Freak-Poli Rosanne , Ryan Joanne , Tran Thach , Owen Alice , Power Joanna McHugh , Berk Michael , Stocks Nigel , Gonzalez-Chica David , Lowthian Judy A , Fisher Jane , Byles Julie
Published: September 2021

Background

Social isolation, lack of social support and loneliness have historically been assessed as overlapping or even interchangeable terms. We aimed to assess whether these three social constructs are independently associated with health-related quality of life (HRQoL).

Methods

This analysis included 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation (Duke Social Support Index: DSSI), social support (DSSI), and loneliness (one-item) were investigated for their association with HRQoL (physical [PCS] and mental [MCS] component scores of the SF-36® questionnaire). Multivariable analyses adjusted for age, demographics, socio-economic position and medical conditions.

Results

Social isolation, social support and loneliness were not strongly correlated with one another. However, all were independently associated with HRQoL (PCS: isolation -0.97, low support -2.24, loneliness -2.70; MCS: isolation -1.96, low support -4.78, loneliness -10.31; p-value<0.001 for each). Compared to those with low social isolation, high social support and lack of loneliness, women highly isolated, with low social support and lonely reported the lowest HRQoL (MCS: -18 to -17; PCS: -8 to -6). Other combinations of isolation, support and loneliness varied in their associations with HRQoL.

Conclusions

Social isolation, social support and loneliness are distinct, yet interconnected concepts that may coexist and are each adversely associated with HRQoL.

Key messages

Ageing populations present the challenge of supporting older people to maintain a longer, healthy, meaningful and community-dwelling lives. Social isolation, low social support and loneliness have adverse associations with HRQoL.
1185The association between neighbourhood built environment and health-related fitness: A systematic review
Authors: Frehlich Levi , Christie Chelsea , Ronksley Paul , Turin Tanvir C , Doyle-Baker Patricia , McCormack Gavin
Published: September 2021

Background

Few studies have investigated potential links between the built environment and health-related fitness, even though there is some evidence linking neighbourhood built environments to physical activity behaviors and chronic health conditions.

Methods

Following PRISMA guidelines eight databases were searched from inception to August 2020 using a combination of built environment and health-related fitness terms. Inclusion criteria was limited to quantitative studies that sampled of adults aged 18 years or older with no physical disabilities or health issues that may impact health-related fitness.

Results

Of the 26,219 citations identified within our comprehensive search, 25 studies met eligibility and underwent data extraction and quality assessment. Objectively measured built environment characteristics (e.g., improved sidewalks, higher street connectivity, older neighbourhoods, higher residential density, and higher land use mix) were associated with increased flexibility, cardiorespiratory fitness, grip strength, and body composition. Moreover, perceptions of neighbourhood features such as higher neighbourhood walkability, greater park access and quality, and lower neighbourhood crime, were associated with increased perceived cardiorespiratory fitness, muscular strength, flexibility, and overall fitness. However, many of these findings were from cross-sectional studies where adjustment for key confounders varied. Results also varied by sex in the small number of studies that provided sex-specific stratifications.

Conclusions

This project may help elucidate the pathway between the built environment and health-related fitness.

Key messages

Neighbourhood built environment features are associated with aspects of health-related fitness.
681Influenza vaccine effectiveness in young Japanese children over five seasons
Authors: Fukushima Wakaba , Morikawa Saeko , Fujioka Masashi , Matsushita Tohru , Kubota Megumi , Yagi Yoshina , Takechi Tetsuhisa , Takasaki Yoshio , Shindo Shizuo , Yamashita Yuji , Yokoyama Takato , Kiyomatsu Yumi , Hiroi Satoshi , Nakata Keiko , Matsumoto Kazuhiro , Maeda Akiko , Kondo Kyoko , Ito Kazuya , Kase Tetsuo , Ohfuji Satoko , Hirota Yoshio
Published: September 2021

Background

Evidence is limited for influenza vaccine effectiveness (VE) against laboratory-confirmed influenza among young children. Using test-negative design (a modified case-control study) which minimizes confounding by health care-seeking behavior and misclassification of diseases, we aimed to monitor influenza VE among young children in Japan where all approved influenza vaccines are egg-propagated, inactivated formulations (IIV).

Methods

For seasons spanning 2013-14 to 2017-18 in Osaka and Fukuoka Prefectures, Japan, we employed prospective, active, and systematic recruitment of children aged <6 years who visited collaborating pediatric clinics within 7 days of influenza-like illness onset. Nasal aspirates were tested for influenza by real-time RT-PCR. Date of vaccination was confirmed by medical records or maternal and child health handbooks. Cases and controls were defined as being PCR-positive and -negative, respectively. Conditional logistic regression models were used to calculate adjusted VE ([1 - adjusted odds ratio] × 100%).

Results

We analyzed 4,614 subjects including 1,917 cases. VEs of IIV with 2 doses approximated 50%, ranging from 41% (95% confidence interval [CI]: 14 % to 60%) in 2016-17 season to 63% (95% CI: 45% to 76%) in 2017-18 season. Significant VEs were also shown for predominant circulating strains every season, irrespective of their antigenic match to vaccine strains (56% and 65% for A[H1N1]pdm, 37% and 50% for A[H3N2], and 60% for B[Yamagata]).

Conclusions

IIV provided modest and significant protection against laboratory-confirmed influenza in young Japanese children.

Key messages

Test-negative design is useful for monitoring influenza VE.
305Interaction between physical activity and nutritional intake on HbA1c in Japanese general population
Authors: Furukawa Takuma , Nishida Yuichiro , Hara Megumi , Shimanoe Chisato , Koga Kayoko , Tanaka Keitaro ,   Japan Multi-Institutional Collaborative Cohort (J-MICC) Study Group J-MICC Study Group
Published: September 2021

Background

Healthy diet and physical activity (PA) are considered important for prevention and treatment of diabetes, particularly as diet and PA combined. However, reports on the interaction between PA and diet are limited, especially from large epidemiological study.

Methods

The present cross-sectional study used data collected from 55,469 participants in non-diabetes general population who completed the baseline survey on the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study. Multiple linear regression was used to adjust for confounding variables and to examine interactions between PA and macronutrient (carbohydrate, fat and protein) intake on HbA1c.

Result

The significant interactions between PA and carbohydrate intake or fat intake, but not protein intake, on HbA1c were observed after adjustment for confounding variables (P interaction = 0.021, 0.004 and 0.164, respectively). The inverse associations between PA and HbA1c were more evident in the participants with high-carbohydrate/low-fat intake compared to those with low-carbohydrate/high-fat intake. Although further adjustment for body mass index (BMI) slightly weakened interactions between PA and carbohydrate/fat intake on HbA1c (P interaction = 0.063 and 0.059, respectively), the associations between PA and HbA1c in the stratified analysis remained.

Conclusion

The present study found the interaction between PA and carbohydrate/fat intake on HbA1c. This finding suggests that the effect of PA on blood glucose control is modified by intake of macronutrient composition.

Key messages

Interaction between PA and macronutrient intake is likely to play an important role in the control of glucose control.
1119Association between socioeconomic status and metabolic control in hospitalized patients with type 2 diabetes
Authors: Murillo José Adrián Geraldo ,   David Sergio Salas Vargas
Published: September 2021

Background

In Mexico, 10.3% of the adult population has type 2 diabetes. Low socioeconomic status (SES) has been considered as a risk factor for developing this disease. The aim of this study was to determine whether SES is associated with blood glucose control, treatment adherence, and diabetic complications.

Methods

A retrospective cross-sectional observational study was conducted in Ensenada, Baja California, México, with a random sample of 103 hospitalized patients between November 2019 and February 2020. The information was collected by face-to-face interview with structured questionnaires and the medical records review. The analysis was performed using the SPSS statistics software.

Results

Of the patients who do not know how to perform self-monitoring of blood glucose (SMBG) in more than half of them were not educated (P = 0.002). Not performing SMBG at home was associated with increased risk of microvascular complications. [OR 2.88 CI 95% 1.20-6.89]. Those who were left without medications due to lack of money had a higher risk of hyperglycemia at home without going to the hospital [OR 3.89 95% CI 1.16-13.05]. Hypoglycemia prevailed in patients who did not perform GA due to lack of money to buy a glucometer. (P = 0.012).

Conclusions

Low socioeconomic status was associated with poor adherence to treatment and lack of self-monitoring of capillary glucose at home.

Key messages

Socioeconomic status, Type 2 diabetes, adherence to treatment, self-monitoring.
559Health of Aboriginal children in Western Australia: Do grandparents matter?
Authors: Gibberd Alison , Preen David , Shepherd Carrington , Eades Sandra , McNamara Bridgette
Published: September 2021

Background

Studies of select populations (e.g. pre-industrial or subsistence farming populations) suggest that children with living maternal grandmothers (MGMs) had improved survival. It is unknown if this holds for child health more generally or in Australian Indigenous communities, where care of children is commonly shared by family members. We examined associations between the health of young Aboriginal Western Australians and their grandparents.

Methods

Birth, death, inpatient and emergency department records of Aboriginal infants born 2000-2013 in WA and their grandparents were linked. Grandparents were classified as ‘healthy’ (alive with Charlson comorbidity index score of 0 or 1), ‘unhealthy’ (alive with a score of ≥ 2), or dead when the child was born.

Results

Among the 27,425 children, mortality by age 2 was lower with healthy grandparents (e.g. 11 deaths per 1000 live births with healthy MGMs; 22 with unhealthy; 16 with dead MGMs) and acute healthcare contacts were fewer (e.g. 13% with healthy MGMs spent ≥7 days in hospital by age 2 vs 19% with unhealthy or dead MGMs). However, healthcare contacts were generally unrelated to grandfathers. Outcomes were better for children with 2 living grandmothers (e.g. 1.5% with 2 grandmothers were discharged against medical advice in 2 years; 2.7% with 1 grandmother; 3.7% with none).

Conclusions

Children with healthy grandmothers had lower mortality and morbidity. These associations are unlikely to be due to genetic or environmental factors, as they are weaker/missing for grandfathers.

Key messages

Good health among older Aboriginal people may also benefit the health of subsequent generations.
1475Effects of climate factors on the dengue fever in Paraguay: generalized additive model in 2014-2020
Authors: Gomez Raquel Elizabeth Gomez
Published: September 2021

Background

Dengue fever is disease transmitted by mostly Aedes spp. This study aims investigate the association between climate factors and dengue incidence in Paraguay, considered as an endemic disease since 2009.

Methods

We extracted incidence of dengue by week from 2014-2020 national health surveillance, Paraguay. The climate factors, including rainfall, sunshine, minimum temperate, air pressure, relative humidity and wind were extracted from Directorate of Meteorology and Hydrology and aggregated as a weekly data. Generalized additive modeling was performed, adjusted by seasonality and population. Lags between 0-10 weeks were chosen for according to rho statistics of Spearman’s test.

Results

A total of dengue fever was 40,593 in study period. The mean cumulative incidence per 10,000 populations was 22.37 (standard deviation: 93.27). All six climate factors and seasonality were significant in the final model with the adjusted R-square 18.6%. Rainfall (relative risk [RR]: 0.51), relative humidity (RR: 0.25) and wind (RR: 0.19) showed negative trends with the increase of dengue while atmospheric pressure (RR: 9.32) and sunshine (RR: 0.12) showed positive associations. Minimum temperature showed increasing trend until 15ºC (1ºC increase in 4-fold incidence). The lag of each factor was selected between 2 to 10 weeks.

Conclusion

Climate factors showed associations with dengue fever in Paraguay. Such climate factors should be considered along with the dengue surveillance in endemic areas for effective dengue control.

Key messages

Climate factors showed significant dynamic associations with dengue incidence in Paraguay.