bluuebunny/crossref_metadata_2025_split huggingface dataset:
1378The effect of vitamin D supplementation on acute respiratory infection -analysis of the D-Health Trial
Authors: Pham Hai , Waterhouse Mary , Baxter Catherine , Romero Briony , McLeod Donald , Armstrong Bruce , Ebeling Peter , English Dallas , Hartel Gunter , Kimlin Michael , Martineau Adrian , O'Connell Rachel , Pols Jolieke van der , Venn Alison , Webb Penelope , Whiteman David , Neale Rachel 
Published: September 2021

Abstract

Background
Observational studies link vitamin D deficiency with acute respiratory tract infection (ARTI) but results from randomised controlled trials are heterogeneous.

Methods
We used data from The D-Health Trial (N = 21,315); ARTI was a pre-specified trial outcome. Participants were men and women aged 60 to 79 years (with volunteers aged up to 84 years), supplemented with monthly doses of 60,000 international units of vitamin D and followed for up to 5 years. Participants were asked to report occurrence of ARTI over the previous month via annual surveys, and a subset of participants completed 8-week respiratory symptom diaries in winter. We used regression models to estimate odds ratios, rate ratios and rate differences.

Results
Vitamin D supplementation did not reduce the risk of ARTI (survey OR 0.98, 95% CI 0.93 to 1.02; diary OR 0.98, 95% CI 0.83 to 1.15). Analyses of diary data showed that vitamin D reduced the average duration by 0.5 days (95% CI 0.2 to 0.7 days) and the average number of days with severe symptoms by 0.4 days (95% CI 0.3 to 0.6 days).

Conclusions
Monthly bolus doses of 60,000 IU of vitamin D did not reduce the overall risk of ARTI but slightly reduce the duration of symptoms in the general population.

Key messages
The reduction in the duration of symptoms suggests a potential impact of vitamin D on the immune response to infection.
646Coffee, Brain Volume and Risk of Dementia and Stroke
Authors: Pham Kitty , Mulugeta Anwar , Zhou Ang , O'Brien John T , Llewellyn David J , Hyppönen Elina 
Published: September 2021

Abstract

Background
Coffee is a highly popular beverage worldwide, containing caffeine which is a central nervous system stimulant. The aim was to examine whether habitual coffee consumption is associated with differences in brain volumes or the risk odds of dementia or stroke.

Methods
Prospective analyses of habitual coffee consumption were conducted in 398,646 participants (age 37-73 years) within the UK Biobank, including 17,702 participants with volumetric MRI information. We examined associations between coffee consumption and brain volume using covariate adjusted linear regression, and with odds of dementia and stroke using logistic regression. All participants were free of dementia and stroke at baseline. We obtained 4,333 incident dementia and 6,181 incident stroke cases.

Results
There were inverse linear associations between coffee consumption and total brain (β per cup -1·42, p = 1·4x10-8), grey matter (-0·92, p = 5·2x10-10), white matter (-0·50, p = 0·002) and hippocampal volumes (-0·01, p = 0·009), but no evidence to support associations with white matter hyperintensity volume (-0·01, p = 0·72). After full covariate adjustment, consumption of &gt; 6 cups/day of coffee was associated with 53% higher odds of dementia compared to consumption of 1-2 cups/day (OR 1.53, 95% CI 1.28, 1.83), with less evidence for an association with stroke (OR 1.17, 95% CI 1.00, 1.37, p = 0.055).

Conclusions
High coffee consumption was associated with smaller total brain volumes and increased odds of dementia.

Key messages
The findings suggest caution at higher levels of coffee consumption, however further studies are required to establish causality, and to explore the clinical relevance of brain volume changes.
307Association between patterns of comorbid mental disorders and mortality-related estimates. A Danish register-based cohort study
Authors: Plana-Ripoll Oleguer , McGrath John J 
Published: September 2021

Abstract

Background
Comorbidity within mental disorders is common, and people with two or more types of mental disorders have shorter life expectancy compared to those with exactly one type. The aims of this study were to: (a) describe the prevalence of combinations of mental disorders; and (b) estimate the excess mortality for each of these combinations.

Methods
We conducted a population-based cohort study including all 7,505,576 persons living in Denmark in 1995-2016. Using national registers, we described the most common combinations of mental disorders and investigated excess mortality by means of mortality rate ratios (MRRs) and differences in life expectancy.

Results
At the end of the 22-year observation, 6.2% individuals were diagnosed with exactly one disorder, and 5.3% with two or more types. People with any combination of disorders had higher mortality rates than those without any diagnosis (MRRs ranging from 1.10 [95% CI 0.67 – 1.84] to 5.97 [95% CI 5.52 – 6.45]) and shorter life expectancies compared to the general population (estimates ranging from 5.06 years [95% CI 5.01 – 5.11] to 17.46 years [95% CI 16.86 – 18.03]).

Conclusions
Mood disorders and neurotic disorders commonly co-occur, and contribute to many different sets of comorbid mental disorders. The association between mental disorders comorbidity and mortality revealed the prominent role of substance use disorders.

Key messages
Our study provides prevalence estimates of the most common sets of mental disorders. In light of the substantial contribution of substance use disorders to premature mortality, efforts related to the ‘primary prevention of secondary comorbidity’ warrant added scrutiny.
588Plasma concentrations of persistent organic pollutants and pancreatic cancer risk
Authors: Porta Miquel , Gasull Magda , Pumarega José , Kiviranta Hannu , Rantakokko Panu , Raaschou-Nielsen Ole , Bergdahl Ingvar , Sandanger Torkjel Manning , Rylander Charlotta , Nøst Therese Haugdahl , Duell Eric , Katzke Verena , Gunter Marc , Vineis Paolo 
Published: September 2021

Abstract

Background
Findings and limitations of previous studies on persistent organic pollutants (POPs) and pancreatic cancer risk support conducting further research in prospective cohorts.

Objective
To investigate the association between plasma concentrations of selected POPs and pancreatic cancer risk.

Methods
Prospective case-control study nested within the EPIC cohort. Participants were 513 pancreatic cancer cases and 1020 matched controls. Concentrations of 22 POPs (organochlorine pesticides, polychlorinated biphenyls, and polybrominated diphenyl ethers) were measured in plasma collected at baseline by GC-MS/MS.

Results
Some, generally moderate effects were observed at higher concentrations of p,p’-DDT, trans-nonachlor, β-hexachlorocyclohexane, and the sum of 6 organochlorine pesticides and of 16 POPs. The odds ratio (OR) for the upper quartile of trans-nonachlor was 1.55 (95% confidence interval 1.06 to 2.26; P for trend=0.025). Associations were stronger in the groups predefined as most valid or relevant. Among participants having fasted &gt;6 hours at blood collection, the ORs were significant for 10 of 11 exposure categories. Higher ORs were also observed among cases with microscopic confirmation than in cases with a clinical diagnosis. Higher ORs were also observed among normal-weight participants, with relevant estimates for all 11 exposure categories. Among participants with a follow-up ≥10 years, estimates were also higher (e.g., for trans-nonachlor: OR = 2.14, 1.01 to 4.53, P for trend=0.035). Overall, trans-nonachlor, 3 PCBs, and the 2 sums of POPs were the exposures more clearly associated with pancreatic cancer risk.

Conclusions
A few moderately increased risks were apparent for the highest concentrations of certain POPs, sometimes with a dose-response relationship.
1169Impact of sex-specific growth centiles in utero - a statewide population cohort study
Authors: Pritchard Natasha , Walker Susan , Tong Stephen , Lindquist Anthea 
Published: September 2021

Abstract

Background
Sex impacts birthweight, with male babies heavier on average. However, growth charts in pregnancy are often sex-neutral. Small babies (&lt;10th centile) are at risk of adverse outcomes. We aimed to identify the impact of using sex-specific charts during pregnancy, and if this detected more babies at risk of stillbirth.

Methods
Retrospective cohort study including all infants born in Victoria from 2005-2015 (n = 529,261). We applied the same growth centiles, either adjusted or not adjusted for fetal sex. We compared overall &lt;10th centile populations, populations of males considered small by sex-specific charts only, and populations of females considered small by sex-neutral charts only. Stillbirth risk was our primary outcome.

Results
Of those &lt;10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of &lt; 10th centile females were reclassified as &gt; 10th centile using sex-specific charts. These females were not at increased risk of stillbirth or adverse outcomes compared with a healthy weight infant, but were at greater risk of being delivered by obstetricians on suspicion of growth restriction. A further 25.0% of male infants were reclassified as &lt; 10th centile by sex-specific charts. These male newborns, compared to a healthy weight baby, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and other adverse outcomes.

Conclusions
Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as &lt; 10th centile, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth.

Key messages
Male babies are heavier than female babies. Thus, ultrasound charts growth charts should be sex-specific.
676The impact of alcohol tax elimination policy on population health in Hong Kong
Authors: Quan Jianchao , Ng Carmen , Leung Gabriel 
Published: September 2021

Abstract

Background
Extensive research has shown that taxes on alcohol reduces consumption and alcohol-related harm. Uniquely among high-income economies, the Hong Kong Government reduced alcohol taxes on wine and beer by half in 2007; and entirely waived all alcohol-related taxes in 2008.

Methods
We adapted the International Model of Alcohol Harms and Policies (InterMAHP) using Hong Kong data to evaluate the health impact of the tax elimination policy changes on alcohol pricing. Prevalence and consumption estimates were calculated from serial Behavioural Risk Factor surveys of health behaviours among the Hong Kong population. We applied the linear approximation of the Almost Ideal Demand System (AIDS) econometric model to estimate the elasticity of demand for on-trade and off-trade sales of alcohol (beer, wine, and spirits) using Euromonitor market sales data. We derived population attributable fractions and relative risks estimates from Hospital Authority morbidity and mortality records.

Results
Alcohol consumption and alcohol-related harms were higher for males. We found the policy change increased alcohol-attributable mortalities, predominately due to increases in cancer, cardiovascular disease, and injuries. The burden of disease was higher in older age groups.

Conclusions
Hong Kong pursued a policy of eliminating taxes on alcohol despite extensive evidence on the effectiveness of taxation as a policy tool. We find empirical evidence this policy change was associated with an increase in alcohol-related harms and detrimental to population health.

Key messages
The alcohol tax elimination policy in Hong Kong was associated with an increase in alcohol-related burden of disease. Reintroduction of alcohol taxes merits consideration.
1156Associations between internet use and overweight/obesity in Nepal: Do gender and urbanity modify these associations?
Authors: Rana Juwel 
Published: September 2021

Abstract

Background
Overweight and obesity, a major risk factor for non-communicable disease (NCD), premature deaths, and disability-is exponentially increasing globally, especially in people in low and middle-income countries (LIMCs). This study, thus, examined the associations between internet use and overweight/obesity in Nepal, and the extent to which these associations vary by gender and urbanity.

Methods
We extracted data available from the nationally representative Nepal Demographic and Health Survey (NDHS) 2016. Body Mass Index (BMI) was the outcome of interest. The use of internet (IU) in the last twelve months and frequency of using internet (IUF) in the last month were the primary exposure of interest. Multivariable ordinal logistic regression models at different levels were fitted to obtain the adjusted effects of exposures.

Results
Of 10,380 study participants, 38.5% were males, and 61.5% were females. About 33% of the respondents were overweight and obese (SA cut-off). The prevalence of IU was 31.3% among adults in Nepal. Results show that the risk of overweight and obesity-SA was significantly 1.79 (95% CI: 1.56, 2.05; p &lt; 0.001) times higher among respondents who used internet less than/at least once in a week, and 2.16 (95% CI: 1.88, 2.48; p &lt; 0.0001) times higher among respondents who used internet almost every day compared to non-users of internet. These associations significantly varied by gender.

Conclusion
Higher frequency of internet exposure has detrimental effect on overweight and obesity in Nepal.

Key messages
Effective public health intervention is essential regarding the detrimental health effects of sedentary lifestyle due to the overuse of internet.
1155Effect of household air pollution on infant and child-mortality in Myanmar
Authors: Rana Juwel , Khan Nuruzzaman , Aliani Razia , Islam Rakibul 
Published: September 2021

Abstract

Background
Household air pollution (HAP) from solid fuel use (SFU) for cooking has been considered as a public health threat, particularly for women and children in low and middle-income countries (LMICs), with limited evidence. Hence, this study investigated the effects of HAP on neonatal, infant, and under-five child mortality in Myanmar.

Methods
The cross-sectional study employed data from the Myanmar Demographic and Health Survey (MDHS), the first nationally representative survey conducted in 2016.

The sample consists of 3249 ever-married mothers with under-five children in the household with a 98% response rate. HAP (coal and biomass), and level of exposure to HAP (no exposure, moderate and high exposure) were exposures. Outcomes were self-reported neonatal, infant, and under-five mortality.

Results
The prevalence of SFU was 79.0%. The neonatal, infant, and the under-five mortality rates were 26, 45, and 49 per 1,000 live births, respectively. The odds of infant (aOR 2.17, 95% CI: 1.21, 3.88) and under-five child (aOR 2.22, 95% CI: 1.24, 3.95) mortality were higher in households with SFU compared with clean fuel use. When applying an augmented measure of exposure to HAP by incorporating both SFU and the kitchen’s location, the likelihoods of infant and under-five mortality were even higher among moderate and highly exposed children compared with unexposed children with similar trends.

Conclusion
Infants and under-five children are at higher risk of mortality from exposure to HAP.

Key messages
Increasing access to cookstoves and clean fuels is imperative to reduce the risk of infants and under-five child mortality in LMICs, including Myanmar.
933Outbreak investigation of canine acquired idiopathic megaoesophagus in Australia, 2017-2018
Authors: Renwick Michelle , Stevenson Mark , Wiethoelter Anke , Mansfield Caroline 
Published: September 2021

Abstract

Background
VetCompass Australia collects de-identified data from primary-care, companion animal practices across Australia, providing a large, representative database. VetCompass data were used to investigate an outbreak of megaoesophagus in dogs in Australia in 2017/2018. A specific proprietary dogfood was hypothesized as the cause.

Methods
The instantaneous daily hazard of megaoesophagus for the period January 2012 to February 2018 was plotted using survival analyses. A case-control study focused on dog demographics and management practices was performed to determine risk factors for megaoesophagus.

Results
There was a 7-fold increase in the incidence rate of canine megaoesophagus from 2014 (0.11 [95% CI 0.02 to 0.58] cases per 100,000 dogs per day) to 2018 (0.82 [95% CI 0.19 to 4.2] cases per 100,000 dogs per day) with greater numbers diagnosed during summer months of the year. The odds of feeding one specific dry dogfood was 325 (95% CI 64 to 1644) times greater for cases, compared with controls.

Conclusions
Evidence obtained through this study strongly suggests that a specific dogfood was responsible for most cases. The food was recalled prior to completion of this research. Further investigation into incidence rates and seasonal patterns of canine megaoesophagus are ongoing.

Key messages
Use of aggregated, de-identified data collected across small animal practices in Australia allowed identification of trends and seasonal patterns of a rare disease in dogs for the first time and provides opportunity for surveillance of this and other companion animal diseases.
86Segmenting persistently high-cost individuals into actionable groups
Authors: Ronksley Paul , Wick James , Campbell Dave , Beall Reed , Hemmelgarn Brenda , Tonelli Marcello , Manns Braden 
Published: September 2021

Abstract

Background
Despite growing evidence describing high cost patients, decision-makers struggle to implement effective strategies to improve care and curb spending in this population. Using a multi-phased approach, we aimed to classify high cost patients into homogeneous subgroups amenable to targeted interventions.

Methods
We linked population-level administrative health data in Alberta, Canada from 2012-2017. We defined “persistently high-cost” as those in the top 1% of cumulative inpatient, outpatient and medication cost in at least two consecutive years. We used latent class analysis to separate this persistent high-cost population into potentially actionable subgroups.

Results
Of the 3,795,067 adults residing in Alberta, 21,361 were ‘persistently high-cost’. Latent class models identified 10 high-cost subgroups: individuals with CKD (19.3% of persistent high-cost individuals), those undergoing joint surgery/replacement and rehabilitation (18.6%), individuals with IBD (11.6%), patients receiving biologics for autoimmune conditions (11.3%), patients receiving high cost drugs for other conditions (11.1%), community-dwelling individuals with multimorbid chronic conditions (9.0%), individuals with schizophrenia (6.8%), individuals with other mental health issues (6.2%), rural individuals with COPD (3.4%), and frail elderly in institutional settings (2.7%).

Conclusions
Latent class analysis was able to identify 10 persistently high-cost groups based on meaningful differences in health care spending, demographics, and clinical diagnoses.

Key messages
This taxonomy will inform the identification of interventions shown to improve care and reduce cost for each subgroup in addition to consultation with key stakeholders to identify and reflect on key barriers and facilitators to implementing identified interventions within the local context.
1026Female-Headed Households: Gender and Health Inequalities
Authors: Saad Ghada , DeJong Jocelyn , Ghattas Hala , Barros Aluisio , Wendt Andrea , Hellwig Franciele 
Published: September 2021

Abstract

Background
Gender norms greatly affect who is the main breadwinner and decision maker in a household. Commonly, in the Middle East and North Africa (MENA) region, males are the household heads and it is believed that female-headed households (FHH) are more disadvantaged compared to male-headed households (MHH). Our analysis identifies a household typology and illustrates differences in social inequalities and child health outcomes by headship gender.

Methods
We used DHS/MICS surveys in MENA to identify three types: MHH, and FHH with/without males. We analyzed differentials in birth registration, care-seeking for health treatment, obesity, stunting and full vaccination, wealth quintiles, head’s education and residence.

Results
Among nine countries with surveys since 2010, the average prevalence of FHH was 12%. Female heads were generally over 50 years and had no or primary education. FHH are generally poorer, especially FHH with no males. In Algeria, Iraq, Morocco and Yemen, the proportions of FHH with males present were larger in the richer quintiles, compared to other household types. Disparities in child indicators varied by country, and were not evident for birth registration, vaccination and obesity. Care-seeking was higher among FHH. Stunting was higher among FHH without males.

Conclusions
Disparities in child health indicators are not evident across the household types. However, there were differences in household wealth and head’s education by household type. Female headship is an important dimension of inequality, but there are differences within that category.

Key messages
Despite being socially disadvantaged, children in FHH received similar healthcare compared to children in MHH.
686Evaluation of the impact of National Health Mission on maternal health outcomes
Authors: Sangwan Garima , Lakshmi P.V.M. , Goel Aarti , Gupta Madhu , Prinja Shankar , Kumar Rajesh 
Published: September 2021

Abstract

Background
The National Health Mission (NHM) was launched in 2005 by the Government of India. As NHM has completed about 15 years (2005-2020), there is a need to review the impact of NHM on health measures.

Methods
Logic model (input-process-output-outcome-impact) was used to measure the impact of National Health Mission on maternal health outcomes in India. We studied the impact of NHM by comparing the proportion of women who had first-trimester registration, institutional delivery, postnatal check-ups before NHM (NFHS- 3 data) and after NHM (NFHS-4 data) among those who had a delivery in the last five years preceding the date of the survey after adjusting for sociodemographic factors, road density, telephone density and health worker density.

Results
The Health worker density increased from 32.67 to 50.29 per 10000 population in post NHM period as compared to pre NHM period. Beds per 10,000 population increased from 4.43 in 2005 to 5.96 in 2015. There was a significant increase in the proportion of first-trimester registration from 57.3% to 67.4%, in institutional delivery rate from 41.6% to 87.7% and postnatal check-ups from 42.4% to 72.3% from the year, 2005 to 2015. The Maternal mortality ratio declined from 250 to 130 per lakh childbirths between 2005 and 2015.

Conclusions
NHM has led to an improvement in maternal health-related outcomes in the country.

Key messages
The learnings from NHM can be utilized to improve further the outcomes for achieving Universal Health Coverage (UHC) by 2030.