bluuebunny/crossref_metadata_2025_split huggingface dataset:
594ICE FALCON: a method more powerful than Mendelian Randomisation for causation assessment
Authors: Li Wenyan , Lu Ciyong 
Published: September 2021

Abstract

Background
Evidence shows that sexual minority adolescents (SMA) have a higher risk of developing emotional and behavioral problems (i.e., internalizing and externalizing problems) than their heterosexual peers, which may subsequently cause an increased risk of suicidality. However, the associations remain unclear and whether biological sex may moderate such associations is still unknown. The current study was conducted among Chinese adolescents to test whether emotional and behavioral problems mediates association between sexual minority status and suicidal behavior and to explore whether such mediation is moderated by biological sex.

Methods
Data were drawn from 7th to 12th grade students of the 2019 School-based Chinese Adolescents Health Survey (n = 16,663). Self-reported questionnaires were adopted and moderated mediation models were performed.

Results
Emotional and behavioral problems (peer, emotional, conduct problems and hyperactivity) partially mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.017, 95% CI = 0.012–0.022) and suicide attempts (indirect effect = 0.010, 95% CI = 0.007–0.014). Greater effects were found among female students than males who self-identified as sexual minorities, suggesting these indirect effects were moderated by biological sex.

Conclusions
Biological sex moderates the indirect effects of emotional and behavioral problems on association between sexual minority status and suicidal behaviors. Early school-based suicide prevention strategies can be targeted at SMA (particularly female students who suffer from emotional or behavioral problems).

Key messages
Emotional and behavioral problems are associated with an elevated risk of suicidality among SMA. Biological sex moderates these associations.
476Associations between prenatal perfluoroalkyl substance exposure and cord thyroid hormones using BKMR model
Authors: Liang Hong 
Published: September 2021

Abstract

Background
Perfluoroalkyl substances (PFASs) are a class of synthetic compounds widely detected in humans. We aimed to examine associations between prenatal PFAS exposure and cord thyroid hormones levels.

Methods
We studied 300 mother-infant pairs in Shanghai-Minhang Birth Cohort Study. We measured eight PFASs in maternal plasma samples collected at 12-16 gestational weeks, and total thyroxine (T4), free T4 (FT4), total triiodothyronine (T3), free T3 (FT3), and thyroid stimulating hormone (TSH) in cord plasma. Bayesian kernel machine regression (BKMR) model was used addressing high correlations between PFAS mixture.

Results
Maternal PFAS mixture was positively associated with cord T3/FT3 concentrations, such that the 75th percentile of PFAS mixture was associated with 0.074 (95%CI: 0.037, 0.146) nmol/l increase in T3 and 0.095 (95%CI: -0.005, 0.195) pmol/l increase in FT3, compared with the 25th percentile. Regarding single-exposure effect, PFOA at 75th percentile was associated with increased T3 (0.0396 nmol/l, 95%CI: 0.007, 0.072), FT3 (0.159 pmol/l, 95%CI: 0.055, 0.264) and TSH (1.50 uIU/ml, 95%CI: 0.379, 2.621), while PFNA was associated with decreased FT3 (-0.148 pmol/l, 95%CI -0.271, -0.0253) and TSH (-1.621 uIU/ml, 95%CI: -2.959, -0.2835). PFDA was associated with increased FT3 (0.112 pmol/l, 95%CI: -0.0311, 0.2559).

Conclusions
Prenatal FPAS exposure was positively associated with T3/FT3 with predominant compounds of PFOA, PFNA, and PFDA.

Key messages
Using BKMR addressing highly correlated PFASs, prenatal exposure to eight PFASs was associated with increased cord T3/FT3 levels with PFOA, PFNA, and PFDA being predominant compounds.
1445Antibiotic susceptibility of Helicobacter pylori in Arctic Canadian Indigenous communities
Authors: Lindsey Lauren , Quilty Doug , Cromarty Taylor , Assi Ali , Zanten Sander Veldhuyzen van , Goodman Karen 
Published: September 2021

Abstract

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. A key concern is poor effectiveness of anti-Hp treatment. We aimed to describe antibiotic resistance patterns in Hp isolated from project participants.

Methods
Participants in 7 communities underwent upper gastrointestinal endoscopy with 2 gastric biopsies taken for tissue culture during 2008-2017. We tested Hp isolates for resistance to 7 antibiotics by Etest and assessed 4 outcomes: resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics. We tabulated proportion positive among isolates tested with 95% confidence intervals (CI) and used logistic regression to assess the relation of age and sex to resistance outcomes.

Results
Of 259 Hp isolates tested, resistance to metronidazole, clarithromycin, 1+ antibiotics, and 2+ antibiotics were (% [CI]): respectively, 35 [29-41], 19 [15-25], 44 [38-50], and 12 [8-17] overall; 38 [30-47], 24 [17-32], 49 [41-58], and 16 [11-23] in 146 isolates from women; and 30 [22-39], 13 [8-21], 36 [27-46], and 6 [3-12] in 113 isolates from men. Odds of resistance to clarithromycin, 1+ antibiotics, 2+ antibiotics, and, to a lesser degree metronidazole, were elevated in women relative to men after age adjustment and increased with age in women but not men.

Conclusion
In Arctic Indigenous communities in Canada, women were more likely than men to harbor antibiotic-resistant Hp, and their frequency of resistant Hp infection increased with age.

Key messages
Community-driven research answers questions posed by those who bear the disease burden.
286Collider-stratification bias when estimating variable importance using Random Forests
Authors: Long Stephanie , Lefebvre Genevieve , Schuster Tibor 
Published: September 2021

Abstract

Background
Advances in causal inference have helped explain the longstanding birthweight and obesity paradoxes: selection bias due to conditioning on a collider variable i.e. collider-stratification bias (CSB). The lessons learned have critical implications for the interpretation of machine learning (ML), including decision trees and random forests (RFs), that implicitly condition on input variables. RFs are a popular approach for identifying important “predictors” from large data through variable importance, defined by the average decrease in prediction accuracy. While CSB has become a recognized concern when estimating exposure-outcome effects, knowledge of its impact on ML’s variable importance measures (VIMs) is limited. Applying the causal inference framework, we investigated the accuracy of RFs’ VIMs in data-mechanisms prone to CSB.

Methods
A Monte Carlo simulation study was conducted, with binary outcome and collider variables generated from logistic models. Two exposure variables stochastically determined the outcome and a collider variable, independent of the outcome. VIMs from RFs were compared to the known causal relevance of the input variables on the outcome.

Results
While variable importance of true exposure variables was not systematically affected by CSB, validity of VIMs can be affected, leading to erroneous selection of collider variables, causally independent of the outcome, as outcome predictors.

Conclusions
In presence of CSB, VIMs are not valid measures of the causal relevance of variables and may mislead selection of truly important factors that affect the outcome.

Key messages
ML must consider causal data-generating mechanisms otherwise it may lead to erroneous assessment of variable importance regarding outcome prediction.
1018Long-term risk of distant metastasis and post-metastasis survival for breast cancer: health record linkage study
Authors: Lord Sarah , Daniels Benjamin , Kiely Belinda , O'Connell Dianne , Pearson Sallie-Anne , Beith Jane , Bulsara Max , Houssami Nehmat 
Published: September 2021

Abstract

Background
After early breast cancer (BC) treatment, women need information about long-term prognosis. In this population-based health record linkage study, we assessed the cumulative incidence of distant metastasis (DM) conditional on the DM-free interval; and BC-specific survival post-metastasis.

Methods
We included all women diagnosed with non-metastatic BC in the NSW Cancer Registry, 2001-2002. We used linked records from hospitals, dispensed medicines, radiotherapy services and death registrations and applied stringent criteria to determine time to first DM and BC death.

Results
6338 women were included (BC: localised 3885, regional 2453). The 5-year cumulative incidence of DM was 7.4% (95% confidence interval 6.6-8.3) for localised BC; 22.8% (21.2-24.5) for regional BC. For women DM-free at 5 years, it was 5.7% (5.0-6.6); and 11.4% (10.0-13.0) to year 10, respectively.
The annual hazard for BC death following localised BC remained lower than that for non-BC causes; for regional BC, it was similar to that for non-BC causes at 8 years.
Following DM (N = 1492), BC-specific survival varied widely (median 25 months, interquartile range 6-127). The probability of surviving BC for ≥5 years was 32.0% (29.4-34.7) overall; and 47.1% (42.6-51.5) for those with a DM-free interval &gt;5 years.

Conclusions
Women’s risk of DM improves over time since diagnosis; and post-metastasis survival is longer for women with later DM.

Key messages
Health record linkage methods can be used for conditional risk estimates to inform women who remain DM-free after early BC about their risk of DM in subsequent years; and post-metastasis survival.
1543Gains in life expectancy in the Australian population due to reductions in smoking: comparisons between interventions targeting the population versus interventions in a specific high risk group
Authors: Mannan Haider 
Published: September 2021

Abstract

Background
Four decades of population-based tobacco control strategies have contributed to substantial reduction in smoking prevalence in Australia. However, smoking prevalence is still double in socially disadvantaged groups compared to those that are not. But not all tobacco control strategies successfully used in the general population is effective in specific high-risk population groups. Hence, an effective way to reduce smoking in high risk population groups may include targeting them specifically to identify and support smokers to quit. In this backdrop, we examined whether tobacco control interventions at the population-level are more effective in increasing life expectancy among Australians compared to interventions targeting a high risk group or a combination of the two when smoking prevalence is reduced to 10 and 0% respectively.

Methods
Using the risk percentiles approach, analyses were performed separately for men and women using data from various sources such as the 2014–15 National Health Survey linked to death registry, simulated data for high risk groups, and the Australian population and deaths data from the census. Indigenous status was simulated by preferentially assigning those who are indigenous to lower SES quintiles. The age-sex distribution of mental disorder status was simulated using its distribution from 2016 National Drug Strategy Household Survey with 25.9% of mentally ill being assigned to current smoking category and the rest to non-smoking category. The age-sex distribution of prisoners was simulated based on 2014 ABS Prisoners Australia survey with 74% of prisoners being assigned to current smoker category and the rest to non-smoker category. Homelessness status was simulated according to age, sex and indigenous status for 2011 census with all homeless being allocated to the lowest SES category. The age-sex distribution of total cholesterol level was simulated based on 2011–13 Australian Health Survey.

Results
The results showed that the combined approach for reducing smoking is most effective for improving life expectancy of Australians particularly for the socially disadvantaged and mentally ill groups both of which have high fraction of smokers in the population. For those who were mentally ill the gain in ALE due to reduction of smoking to 10% was 0.53 years for males and 0.36 years for females which were around 51 and 42% respectively of the maximal gains in ALE that could be achieved through complete cessation.

Conclusions
Targeting high-risk population groups having substantial fraction of smokers in the population can strongly complement the existing population-based smoking reduction strategies. As population and high risk approaches are both important, the national prevention policies should make judicious use of both to maximize health gain.
1182Vaccine hesitancy among health care workers: A study amidst COVID-19 vaccine drive in India
Authors: Mathur Medha , Mathur Navgeet 
Published: September 2021

Abstract

Background
After the launch of COVID-19 vaccine by the government of India in 2021, the current study was conducted to assess the vaccine hesitancy among health care workers regarding COVID-19 vaccination and its safety, efficacy, rolling out strategy and undesirable effects.

Methods
This cross-sectional study, conducted on health care workers vaccinated at a tertiary care center of southern Rajasthan using a pre-designed and pre-validated questionnaire to collect data through the ‘Exit Interview’ technique after consent and ethical approval.

Results
Out of 3102, 56.8% were male and 43.2% were female health care workers. Out of total 80.7% and 73.2% of study participants perceived the vaccine as safe and effective respectively. The vaccine hesitancy was contributed due to apprehension for undesirable effects following immunization (19.3%). The commonest undesirable effect was pain at the injection site. The perception regarding the timing of rolling out of vaccine and readiness for COVID appropriate behavior after vaccination was significant (p &lt; 0.001). The mean time spent at vaccination site was 33.90 (±11.34) minutes ranging 5-120 minutes (median = 35; interquartile range (IQR) = 10; 95% confidence interval (CI) = 33.50-34.30).

Conclusions
The study concludes that the apprehension of undesirable effects contributed to vaccine hesitancy, but it was perceived safe and effective by health care workers.

Key messages
The vaccine hesitancy among general population and vaccine acceptance will be affected directly by instance shown by health care workers who presented themselves at the forefront both for battling the pandemic and accepting the vaccine.
267Cardiovascular preventive pharmacotherapy stratified by cardiovascular risk in a complete New Zealand primary prevention population
Authors: Mehta Suneela 
Published: September 2021

Abstract

Background
Many countries, including Aotearoa/New Zealand, have guidelines recommending cardiovascular disease (CVD) management based on predicted risk. We conducted the first study to examine CVD preventive pharmacotherapy, stratified by CVD risk, within a complete national primary prevention population.

Methods
Anonymised individual-level linkage of New Zealand administrative health and non-health data identified 2,250,201 individuals without atherosclerotic CVD, alive and aged 30-74 years on 31/03/2013. We identified individuals with ≥1 dispensing by community pharmacies of blood pressure lowering (BPL) and/or lipid lowering (LL) medications at baseline (1/10/2012-31/3/2013) and in 6-month periods between 1/04/2013-31/03/2016. Individuals were stratified by 5-year CVD risk.

Results
One quarter of individuals had ≥5% 5-year risk (current New Zealand guideline threshold for considering preventive medications) and 5% met the ≥15% risk threshold for recommended dual therapy. Baseline dual therapy varied according to 5-year risk: 1% with &lt;5%, 15% with 5-9%, 31% with 10-14% and 47% with ≥15% risk. Among those dispensed baseline dual therapy, 83%-89% across risk strata were still treated after three years. Initiation of dual therapy during follow-up occurred among only 13% of high-risk individuals; people without diabetes and those aged ≥65 years were more likely to remain untreated. There were few differences in treatment maintenance across clinical/demographic sub-groups.

Conclusions
CVD primary preventive pharmacotherapy was strongly associated with CVD risk and, once commenced, was generally continued. However, only half of high-risk individuals received recommended dual therapy and treatment initiation was modest.

Key messages
Individually-linked administrative datasets can identify clinically-relevant quality improvement opportunities for an entire national population.
222Long-term mortality after early famine exposure: findings from the China Kadoorie Biobank
Authors: Meng Ruogu , Yu Canqing , Guo Yu , Bian Zheng , Yang Ling , Chen Yiping , Du Huaidong , Chen Junshi , Chen Zhengming , Lv Jun , Li Liming 
Published: September 2021

Abstract

Background
Previous studies suggested that increased risks of chronic diseases in China might be attributable to early experience of the Chinese Great Famine during last century, but the reliable evidence for adult mortality was rare. This study is to investigate the association of early famine exposure with death risks in the middle age.

Methods
A number of 94 051 participants from China Kadoorie Biobank were categorized as non-famine births (born between 10/1/1956 and 9/30/1958, and 10/1/1962 and 9/30/1964) and famine births (born between 10/1/1959 and 9/30/1961). The outcomes were total and cause specific mortality. Cox regression was used to estimate hazard ratio (HR) for famine exposure.

Results
During a median 10.2 years of follow-up, we documented 2802 total deaths in all participants. Prenatal famine exposure was only associated with the risks of ischemic heart disease (IHD) mortality in adulthood (310 deaths, HR [95% CI]: 1.34 [1.02, 1.75]), compared with non-famine births. We also observed the association of famine with total mortality (HR [95% CI]: 1.42 [1.12, 1.78]) in daily alcohol drinkers, but not in non-daily drinkers (P for interaction: 0.025).

Conclusions
This study indicated that early famine exposure was associated with an increased death risk of heart disease and such risk may be modified by adult alcohol consumption.

Key messages
Early Chinese famine experience might impact adult IHD deaths.
Coexistence of early famine experience and adult alcohol consumption was associated with higher risks of total mortality.
117A digital resource for enhancing parental health literacy during the transition to parenthood
Authors: Middleton Nicos , Kolokotroni Ourania , Christodoulides Veronica , Hadjigeorgiou Eleni , Gourounti Claire , Leinweber Julia , Gouni Olga , Lykeridou Katerina , Sarantaki Antigoni , Karanikola Maria , Nicolaou Christiana , Kouta Christiana , Bachetta Britta , Papain Shabira , Pedersen Eline , Baum Alison 
Published: September 2021

Abstract

Background
While the transition to parenthood is critical for mother-child health, traditional antenatal education has been questioned. Digital resources provide opportunities for reducing social disparities and enhancing health literacy, particularly important in a medicalized and decentralized birth environment with high caesarean and low breastfeed rates.

Methods
Within a Participatory Action Research (PAR) framework, formative qualitative and quantitative methods were employed to assess the cross-national transferability of Baby Buddy (UK), and deliver a locally relevant resource to inform, enhance user-provider communications and support shared decision-making.

Results
Using consensus-building and priority-setting techniques, we engaged with the local health professional community and parents-to-be to assess available resources, identify gaps and priorities in an eDelphi survey (N = 275 mums, 193 professionals) and gain an in-depth understanding on information-seeking behaviours and participation in decision-making in a series of focus groups with antenatal educators (N = 20) and new mums/ mums-to-be (N = 62). New material was co-created with participants and an intervention for embedding the tool in clinical practice was proposed within the COM-B behavioural change framework.

Conclusions
The project is a “proof of concept” for exchange of innovation and a “complimentary” model of maternal healthcare delivery. Beyond a learning experience for the participants, the use of PAR provided ground for building transdisciplinary alliances.

Key messages
Other than enhancing health literacy, digital resources can support the educational role of health professionals
PAR provides a framework to engage with the community, building a sense of common purpose
1395Estimates of people infected with soil-transmitted-helminthiasis and drug requirements for preventive chemotherapy in Ogun, Nigeria
Authors: Mogaji Hammed , Olatunji Johnson , Adigun Abass , Ekpo Uwem 
Published: September 2021

Abstract

Background
Soil transmitted helminthiasis (STH) are among the most common human infections worldwide with over 1 billion people affected. This study produced predictive risk maps of STH and estimated the number of people infected, and the amount of drug required for preventive chemotherapy in Ogun state, Nigeria.

Methods
Georeferenced STH infection data obtained from community cross-sectional survey, at 33 locations between July 2016-November 2018, together with remotely sensed environmental and socio-economic data were analyzed using Bayesian geostatistical models.

Result
An overall prevalence of 17.2% (95 % CI: 14.9, 19.5) was recorded for STH infection. Ascaris lumbricoides infections was the most predominant, 13.6% (95% CI: 11.5, 15.7), while Hookworm and Trichuris trichiura had 4.6 % (95% CI: 3.3, 5.9) and 1.7% (95 % CI: 0.9, 2.4), respectively. The predictive maps reveal a spatial pattern of high risk in the central, western and on the border connecting Republic of Benin. The model identified soil pH, soil moisture and elevation as important predictors of the STH infection. Approximately 1.1 million persons (preschoolers, school-aged children (SAC) and adults) are infected and requires 7.8 million doses. Also, 375,374 SAC were estimated to be infected, requiring 2.7 million doses for annual PC.

Conclusion
Our predictive risk maps and estimated PC needs provide useful information for the elimination of STH, by identifying priority areas for delivery of interventions in Ogun State, Nigeria.
1136Leveraging on waste management for supplemental vaccinations to incinerate wastes from routine immunization in nigeria
Authors: Momoh Jenny 
Published: September 2021

Abstract

Background
Nigeria, in 2019, implemented an Integrated Measles and Meningitis A vaccination campaign (IVC) majorly in the northern part of the country including the Federal Capital Territory (FCT), Abuja. The campaign was necessary to interrupt the transmission of these diseases in unimmunized under-fives. FCT aligned with this novel approach to reach its target population of 692697 children aged 9-59 months and 651951 children aged 1-5 years with the Measles and Men A vaccines respectively. Given the integration, FCT was going to generate twice the volume of wastes compared to previous stand-alone campaigns. This paper aims to document the best practices FCT used to incinerate the large volume of sharp wastes generated during the IVC as well as outstanding wastes generated during routine immunization (RI) services.

Methods
A waste management working group was inaugurated at the state level to coordinate all waste management activities in FCT. They developed a waste management plan outlining the expected amount of wastes to be generated, cost implications, mapping of incineration sites and modalities of evacuation and incineration.

Result
A total of 20000 safety boxes generated from the integrated Measles and Men A vaccination campaign (17645) and RI (2355) were incinerated.

Conclusion
FCT has incinerated all sharps generated during the 2019 integrated Measles and Men A vaccination campaign as well as outstanding routine immunization wastes.

Key message
Coordinated waste management activities are required to continuously manage RI wastes.