bluuebunny/crossref_metadata_2025_split huggingface dataset:
656Risk factors for lung cancer in never-smokers in Australia
Authors: Cheng Elvin , Weber Marianne , Steinberg Julia , Canfell Karen , Yu Xue Qin 
Published: September 2021

Abstract

Background
Lung cancer in never-smokers (LCINS), if considered as a distinct type, would rank as Australia’s eighth most deadly cancer. We investigated several demographic, lifestyle and health-related risk factors for LCINS in Australia.

Methods
Using the longitudinal 45 and Up Study cohort with 267,153 New South Wales (NSW) residents aged ≥45 years at recruitment (2006-2009), we quantified the relationship of 20 potential risk factors with LCINS. Self-reported never-smoking participants who were cancer-free at baseline were followed for incident lung cancer (LC), and adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case-control study including 10,781 NSW residents aged ≥18 years, was also used to examine 16 potential risk factors for LCINS. Adjusted odds ratios (OR) and 95% CI for LC were estimated using logistic regression.

Results
In the 45 and Up Study, there were 226 LC cases among 132,354 cancer-free never-smokers with a median follow-up of 5.41 years. In the CLEAR Study, there were 58 LCINS cases and 1316 cancer-free never-smoking controls. After adjusting for potential confounders, analyses of both datasets showed that Asian-born participants had a higher risk of LCINS than those born elsewhere: cohort HR = 2.83 (95% CI: 1.64-4.89) and case-control OR = 3.78 (95% CI: 1.19-12.05).

Conclusions
Our findings support the growing evidence that never-smokers born in Asia are at higher risk of developing LC than those born elsewhere.

Key messages
Region of birth could be considered when assessing potential LC risk among never-smokers.
1069Reflection from working with multi-disciplinary teams on practice of teaching epidemiology
Authors: Chih HuiJun , Firth Ann 
Published: September 2021

Abstract

Focus of Presentation
Health research teams has increasingly worked together as multi-disciplinary teams. Sponsorships and/or fellowships may provide teaching academics the opportunity to collaborate with multi-disciplinary teams on real-life research and enhance their teaching practice. This presentation will focus on sharing reflection of a teaching academic working with multi-disciplinary teams, and the experience on influencing the academic’s practice of teaching epidemiology.

Findings
The opportunity to work with multi-disciplinary clinicians has been enriching. In addition to building networks, it has helped to build confidence of the academic in clarifying unit learning outcomes, developing well-aligned curricula and designing authentic activities that scaffold threshold concepts effectively to assist students achieve the unit learning outcomes. The confidence of students on the teaching academic is also enhanced as they gain quantitative research skills on real-life examples, which would be useful for the future workforce.

Conclusions/Implications
The opportunity for academic who teach epidemiology to work with multi-disciplinary research teams can bring along positive outcomes. It not only enhances research outputs of both parties, teaching capability of the academic, but also the confidence of our future workforce in the area of epidemiology.

Key messages
Teaching academics need opportunities to work with the industry in order to effectively bridge the teaching-research nexus in both directions, and create win-win-win situations for the academics, the students and the industry collaborators.
176Associated factor for abnormal cervical citology in women with HIV at a hospital in Peru
Authors: Chincha Omayra , Samalvides Magister Frine 
Published: September 2021

Abstract

Background
Women living with HIV (WLWH) are at higher risk of abnormal cervical lesions. The aim of this study was to determine the risk factors associated with abnormal cytology in WLWH

Methods
A case-control study was performed, all WLWH &gt;18 years were enrolled at Cayetano Heredia Hospital during 2012-2015. A case and control were defined as a WLWH with abnormal pap smear and with normal pap smear, respectively. Factors associated with the increased risk of abnormal pap smear in WLWH were assessed using logistic regression modeling

Results
We assessed 141 cases and 227 controls. Alcohol consumption was diagnosed in 30.5% (43/141) of the case group and 18.1% (41/227) of the control group. In the case group, 75.2% (106/141) were on antiretroviral treatment (ART) while 85.1% (193/227) in the control group were in ART. Additionally, 37% of cases (40/106) and the 23.1 % of controls (40/173) had virologic failure. The multivariate model showed that alcohol consumption (OR 1.77, IC95% 1.06-2.95), be in virologic failure (OR 2.41, IC95% 1.55-3.74) and were on ART (OR 0.07, IC95% 0.02-0.23) were associated with abnormal cytology

Conclusions
Alcohol consumption and virologic failure are significant risk factors associated with abnormal cytology. ART was found to be a protective factor. Screening for these factors in WLWH, should be considered for promoting the prevention with pap smear.

Key message
We have to have consider periodic screening with pap smear for cervical cancer in this population as mandatory
91Is rainfall associated with paediatric acute gastroenteritis in an affluent setting? A 21-Year Retrospective Investigation
Authors: Chong Ka Chun , Chan Emily , Lee TC , Kwok KL , Lau SYF , Wang P , Lam HCY , Goggins W , Mohammad K , Leung SY , Chan PKS 
Published: September 2021

Abstract

Background
Although many literatures demonstrated heavy rainfall was associated with an increased risk of acute gastroenteritis via contaminated food and water, we hypothesized there is no association between rainfall and paediatric acute gastroenteritis in a setting with high-standard food and water hygiene.

Methods
Intestinal infection-related hospital admissions data during 1998-2018 for children under 5 years of age in Hong Kong were collected. Meteorological data were collected from the Hong Kong Observatory. A distributed lag nonlinear model was employed to examine the associations between meteorological factors and the risk of hospital admissions due to acute gastroenteritis.

Results
Rainfall did not exhibit a statistically significant association with the risk of paediatric admission due to acute gastroenteritis but low temperature, low and high relative humidity did. The risk was 6.3% higher (95% confidence interval: 0.3% to 12.6%) when temperature was at 15.1oC (i.e. the 5th percentile). The adjusted relative risk was statistically significantly higher when relative humidity was ≤73.0% or ≥ 84.0%.

Conclusions
Text: We suggest rainfall playing a minor role in disease transmission via contaminated food and water in affluent societies like Hong Kong. Instead, we speculate low temperature and humidity extremes have greater impact on transmission through increased stability and infectivity of enteric viruses.

Key messages
Weather plays a minor role in food and water contamination in affluent societies.
Low temperature and humidity extremes might improve survival of enteric viruses.
1007Vitamin B6 intake, its active form pyridoxal 5’-phosphate, and markers of B6 activity and catabolism
Authors: Clasen Joanna , Heath Alicia K , Van Puyvelde Heleen , Huybrechts Inge , Johansson Mattias , Ferrari Pietro , Park Jin Young , Brennan Paul , Riboli Elio , Muller David C 
Published: September 2021

Abstract

Background
Several biological pathways implicated in cancer risk rely on vitamin B6, which can be measured in its active form pyridoxal 5’-phosphate (PLP). Functional markers of B6 enzymatic activity have been proposed, including the homocysteine:cysteine ratio (Hcy:Cys, a marker of transsulfuration), 3-hydroxykynurenine ratio (HKr, a marker of tryptophan catabolism), and the 4-pyridoxic acid ratio (PAr, a marker of B6 catabolism). We investigated the extent to which these markers are associated with B6 intake.

Methods
Data from 4,750 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study were included. We estimated the expected percentage change in each of the markers (PLP, Hcy:Cys, HKr, and PAr) for a doubling in B6 intake using log-linear Bayesian hierarchical regression models with log-transformed intake and biomarker data.

Results
The percent change (posterior mean [95% Credible Interval (CrI)]) for a doubling of B6 intake was 61.0 [51.2, 71.8] for PLP, -12.7 [-15.2, -9.9] for Hcy:Cys, -12.9 [-15.7, -9.9] for HKr, and 1.3 [-3.5, 6.2] for PAr.

Conclusions
B6 intake is most strongly associated with PLP, but is also associated with functional markers of transsulfuration and tryptophan catabolism, in the direction of increased activity in these pathways. There is no evidence of a linear association between vitamin B6 intake and catabolism.

Key messages
Our results show differing sensitivity of PLP, markers of tryptophan catabolism and transsulfuration, and vitamin B6 catabolism to B6 intake.
616BMI and SBP impact on survival of dialytic patients: multivariate joint model approach
Authors: Colugnati Fernando , Fernandes Natalia , Franco Marcia 
Published: September 2021

Abstract

Background
Studies on impact of routine clinical parameters on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Although association between body mass index (BMI) and systolic blood pressure (SBP) is well known, their joint role on PD patient evolution is not clear. We aimed to model the joint impact of BMI and SBP trajectories on a cohort of incident elderly PD patients.

Methods
Prospective multicenter cohort study with 674 patients. Repeated measurements were modeled by random effects multivariate linear model. For the time-to-event outcome, used Cox proportional hazards model with log-Gaussian frailty. Stochastic dependence is captured by allowing random effects of the linear model to be correlated with the frailty term of the survival model, allowing for different clinical interpretations. All sub-models were adjusted for age in years.

Results
Isolated current values effects of increased BMI and BPS showed both as protective factors (1% and 2% risk reduction, respectively, for each unitary increase). When jointly modeled BMI changed its effect to 5% risk reduction while BPS remained the same, showing great impacts on survival depending on the combination of trajectories.

Conclusions
Clinical parameters association and its impact on survival is complex, and estimation of isolated effects may provide biased survival curves leading to unrealistic prognosis. A multivariate joint modeling can be seen as a valuable tool for clinical protocols on patient evolution.

Key message
Modern clinical epidemiology must foster use of modern statistics
1087Ethnic inequalities in reproductive health in Latin America
Authors: Costa Janaina Calu , Gatica-Dominguez Giovanna , Victora Cesar , Barros Aluisio 
Published: September 2021

Abstract

Background
African descendants continue to be affected by discrimination in the Americas. We assessed ethnic inequalities in sexual/reproductive health (SRH) in Latin American countries.

Methods
Using data from national surveys we analyzed SRH in nine countries. Absolute differences in coverage for Afro women and the country-specific reference group (usually full or mixed European ancestry) were estimated for contraception with modern methods (CPmo), family planning needs satisfied with modern methods (FPSmo), 4+ antenatal care visits (ANC4), and antenatal care start in the first trimester (ANC1st). The slope index of inequality (SII) was used to assess wealth-based inequalities.

Results
Afrodescendants represented from 2.4% of the sample (Costa Rica) to 56.4% (Brazil) and SRH coverage was lower for Afros compared to the reference. Average difference was of 4 percent points (pp) for CPmo and 6pp for FPSmo, and respectively 7pp and 11pp in the poorest group. The lower average difference (0.64) was found for ANC4, however Colombia had a gap of 7pp. For ANC1st, ethnic differences were &gt;5pp in Brazil, Colombia, Ecuador and Suriname. Suriname had systematically lower coverage among Afros. In Honduras Afros presented similar/higher coverage than the reference. Positive SII revealed coverage concentrated in the richest group for all indicators, however the wealth-based inequalities were much greater among Afros, especially for ANC1st (mean SII = 23pp).

Conclusion
Lower coverage for Afro women is pervasive and worse for the poorest ones.

Key messages
Such evidence can help overcome ethnic long-term disadvantage in the Americas.
1457Aboriginal and/or Torres Strait Islander deaths by suicide in Australia
Authors: Cutler Tessa , Pirkis Jane , Eades Sandra , Gibberd Alison , Gubhaju Lina 
Published: September 2021

Abstract

Background
The fifth leading cause of death for Aboriginal people in Australia is suicide. These deaths are preventable, and their impact is significant for family and the wider community. This work aims to increase understanding of suicide deaths among Aboriginal people by describing these deaths by a range of factors, and identifying similarities and differences between Aboriginal and non-Aboriginal deaths by suicide.

Methods
Suicide deaths in Australia from 2001 to 2019 will be identified from the National Coronial Information System database. Demographic factors, details of the deaths and geographic factors will be described, and comparisons will be made between Aboriginal and non-Aboriginal deaths by suicide. Overall suicide rates by Aboriginal status and age- and sex-standardised rates per 100,000 person-years will be calculated using mid-year estimated resident population and death counts stratified by year, age, sex, and Aboriginal status from the Australian Bureau of Statistics.

Results
The analysis for this work is currently underway and will be finalised prior to the conference.

Conclusions
The results of this research will provide information about sub-groups of the Aboriginal population and areas of Australia with heightened and reduced risks and rates of suicide. The findings will be interpreted with guidance from the Aboriginal Advisory Committee involved in this work. Findings will be shared with service providers, policymakers, communities, and researchers to enable improved targeting of interventions.

Key messages
Better understanding of Aboriginal deaths by suicide is critical to inform and improve the much-needed targeting of services and interventions.
1223Handling missing data for causal effect estimation in cohort studies using Targeted Maximum Likelihood Estimation
Authors: Dashti Ghazaleh , Lee Katherine J. , Simpson Julie A. , White Ian R. , Carlin John B. , Moreno-Betancur Margarita 
Published: September 2021

Abstract

Background
Causal inference from cohort studies is central to epidemiological research. Targeted Maximum Likelihood Estimation (TMLE) is an appealing doubly robust method for causal effect estimation, but it is unclear how missing data should be handled when it is used in conjunction with machine learning approaches for the exposure and outcome models. This is problematic because missing data are ubiquitous and can result in biased estimates and loss of precision if handled inappropriately.

Methods
Based on a motivating example from the Victorian Adolescent Health Cohort Study, we conducted a simulation study to evaluate the performance of available approaches for handling missing data when using TMLE with machine learning. These included complete-case analysis; an extended TMLE approach incorporating an outcome missingness probability model; the missing indicator approach for missing covariate data (MCMI); and multiple imputation (MI) using standard parametric approaches or machine learning algorithms. We considered 11 missingness mechanisms typical in cohort studies, and a simple and a complex setting, in which exposure and outcome generation models included two-way and higher-order interactions.

Results
MI using regression with no interactions and MI with random forest yielded estimates with the highest bias. MI with regression including two-way interactions was the best performing method overall. Of the non-MI approaches, MCMI performed the worst

Conclusions
When using TMLE with machine learning to estimate the average causal effect, avoiding standard MI with no interactions and MCMI is recommended.

Key messages
We provide novel guidance for handling missing data for causal effect estimation using TMLE.
1539Australia’s worsening mental health – what’s next?
Authors: Dawadi Shrinkhala , Shawyer Frances , Teede Helena , Meadows Graham , Enticott Joanne 
Published: September 2021

Abstract

Background
The population prevalence of mental illness over time, and by sociodemographic subgroups, are important benchmark data. Examining reliable population level data can highlight groups with greater mental-illness related symptom burden and inform policy and strategy.

Methods
Secondary analysis of Australian National Health Surveys (n = 78,204) from 2001-02 to 2017-18. Trends in the prevalence of very high scores on the Kessler-10 (K10), a measure of psychological distress capturing symptoms of affective and anxiety disorders, were examined by time, age, gender, and socioeconomic status. Data were standardised to the 2001 Australian census population on the strata of sex and age.

Results
In 2017-18, the rate of probable mental illness was estimated at 5.1%, a 1.5% increase (representing an additional 367,000 Australians) since 2007. In 2017-18, the subgroups with the highest rates were women aged 18-24 (8.01%, 95% CI = 5.9%-10.2%), and the poorest fifth of Australians (8.02%, 95% CI = 7.0%-9.0%). Women aged 55-64 demonstrated the greatest increase in rates (2001: 3.5%, 95% CI = 2.5%-4.6%; 2017: 7.2%, 95% CI = 5.9%-8.5%; z = 4.10, p ≤ 0.001).

Conclusions
Despite efforts to improve population mental health, rates of probable mental illness in Australia have increased since 2007. Findings will be discussed in conjunction to extant social and health policies, and potential gaps in the delivery of gold-standard mental health care.

Key messages
The rate of probable mental illness in Australia seem to be increasing, especially in women aged 55-64, and those from low-SES backgrounds.
1097Inequalities in full vaccination coverage by maternal education and wealth quintiles in South Asian countries
Authors: Dharel Dinesh , Paudel Yuba Raj , Bhattarai Asmita , Subedi Rajkumar , Acharya Kiran 
Published: September 2021

Abstract

Background
Estimated one in four children is not fully immunized in South Asia. This study aimed to compare full vaccination coverage in the region and its inequalities by maternal education and household wealth quintile.

Methods
We used data from the most recent Demographic and Health Survey (DHS) from Nepal, India, Pakistan, Bangladesh, Afghanistan, and the Maldives. Children aged 12-23 months were included. We defined full vaccination as receiving at least six antigen: Bacille Calmette Guerin, Diptheria, Pertussis, Tetanus, Polio, and Measles. We measured absolute inequalities using the slope index of inequality (SII), and relative inequalities using the relative index of inequality (RII) both for maternal education and household wealth quintiles.

Results
The full vaccination coverage ranged from 46% in Afghanistan to 84% in Bangladesh. Pakistan had the largest inequalities in coverage by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). The SII by wealth quintiles was smaller (-8.4) in Nepal compared to Bangladesh, India, Pakistan, and Afghanistan, but it was larger (-30.5) by maternal education compared to Bangladesh and India, although smaller than Pakistan and Afghanistan. The RII followed a similar trend.

Conclusions
All South Asian countries studied had full vaccination coverage under 85%. Both absolute and relative inequalities were larger by maternal education compared to wealth quintile in four of the six countries.

Key messages
Larger inequalities by maternal education compared to wealth-based inequalities in most South Asian countries indicate the critical role of maternal education to improve child health outcomes.
461Alcohol use and anti-retroviral adherence among people living with HIV in ART centre of Nepal
Authors: Dhungana Upendra , Pahari Durga Prasad , Poudyal Amod Kumar 
Published: September 2021

Abstract

Background
Alcohol use is known to have higher prevalence among HIV infected individuals. Hazardous use of alcohol in many studies is negatively associated with the adherence to antiretroviral therapy. Use of alcohol and ART adherence among PLHIV is inadequately explored in Nepalese context. This study aimed at identifying the level of alcohol use and its relationship with adherence to ART among PLHIV.

Methods
A total of 205 PLHIV of age 18 years or more were randomly selected at a national ART centre of Nepal. Self-reported adherence questionnaire was used to get the level of adherence, Alcohol Use Disorder Identification Test (AUDIT) with five questions was adopted for screening the hazardous alcohol use. Those who took more than 95% of the prescribed doses were considered as adherent.

Results
About 86% of the respondents were adherent to ART in four days recall. About one third of the respondents were alcohol user and 40% of them had hazardous use of alcohol. Those having hazardous use of alcohol were four times (AOR=4.60, 95% CI 1.27,16.62) more likely to be non-adherent as compared to those who had not hazardous use of alcohol. Multivariate analyses adjusted ethnicity, Knowledge on dangers of non-adherence, subjective feeling of own health, use of memory aid, IDU background, treatment substitution and depression category.

Conclusion
Hazardous use of alcohol was independently associated with non-adherence with the ART.

Key message
Screening at the start of the treatment and intervention targeting alcohol use may improve HIV outcomes in individuals with hazardous alcohol use.
1263Exploring postgraduate epidemiology competencies in the Australian context
Authors: DiSipio Tracey , Finnane Anna , Protani Melinda , Hall Lisa 
Published: September 2021

Abstract

Background
In response to emerging challenges faced by epidemiologists, it is timely to ensure that university teaching aligns with the competencies required in professional practice. Therefore, the field requires a regular evaluation of the educational competencies being covered. The aim of this research was to seek consensus from both students and experts on postgraduate epidemiology competencies relevant to the Australian context.

Methods
A two-round online survey using a modified Delphi method was used to establish expert consensus on postgraduate epidemiology competencies. Focus groups were also conducted with recent graduates who completed a postgraduate epidemiology course to assess their viewpoints on learning experiences and employability.

Results
In total, 41 experts participated in the first Delphi round. A total of 19/40 factors (general epidemiologic methods/concepts) reached consensus in the first round for importance (high/most important by &gt; 70% of participants). Seventeen factors also reached consensus in terms of feasibility (usually/always/very feasible by &gt; 70% of participants). Further results from the second Delphi round focusing on advanced analysis skills, applied fields and professional/transferrable skills will be available for presentation at the Conference. One main theme emerging from the graduate focus groups was the substantial value gained in undertaking a dissertation, acknowledging its benefit for applying research skills and for networking opportunities.

Conclusions
Competencies for postgraduate epidemiology students require periodic review to safeguard a workforce that can meet emerging challenges.

Key messages
To ensure that high quality epidemiological research and practice continues we need consensus on the set of essential skills required of graduating students.