bluuebunny/crossref_metadata_2025_split huggingface dataset:
1499Health behaviours as risk factors of COVID-19 incidence in South Korea
Authors: Kim Jeehyun , Yoo Daesung , Hong Kwan , Yum Sujin , Gómez Raquel Elizabeth Gómez , Chun Byung Chul 
Published: September 2021

Abstract

Background
Personal health behaviours, which rely on community characteristics, could affect individual vulnerability on disease infection. Due to insufficient study to examine health behaviours as risk factors of COVID-19 infection, we conducted municipal level spatial analysis to investigate association between health behaviours and COVID-19 incidence.

Methods
We extracted cumulative COVID-19 incidence data from January 20th 2020 to February 25th 2021, health behaviours, health condition, socio-economic factors, and covariates in municipal level from publicly available dataset. We chose variables, which were standardized, considering multicollinearity (VIF&lt;10). Further, we employed bayesian hierarchical negative binomial model with intrinsic conditional autoregressive (iCAR) and Besag, York and Mollié (BYM) model, and used deviance information criterion (DIC) for final model selection.

Results
The mean cumulative COVID-19 incidence per 10,000 population among 229 municipality was 13.73 (Standard deviation=11.43). iCAR model (DIC=2,825.3) outperformed BYM model (DIC=14,009.4). The results of iCAR model highlighted that incidence was associated with dental hygiene practice (incidence risk ratios [IRR]=0.92, 95% Credible Interval [CI]=0.85–1.00), whether tried to be thin (IRR=1.10, 95% CI = 1.00–1.20), proportion of medical personnel (IRR=1.09, 95% CI = 1.01–1.17), and volume of public transportation (IRR=1.19, 95% CI = 1.05–1.35), even after adjusting for various confounding factors.

Conclusions
Municipality with lower cumulative incidence was likely to have more people who practiced to keep dental hygiene and less people who tried to be thin.

Key messages
Municipal level spatial analysis resulted that health behaviours were associated with COVID-19 incidence in South Korea.
1354Delivery channels and socioeconomic inequalities in coverage of RMNCH interventions: analysis across 36 LMICs
Authors: Leventhal Daniel , Crochemore-Silva Inácio , Vidaletti Luis , Armenta-Paulino Nancy , Barros Aluísio 
Published: September 2021

Abstract

Background
Socioeconomic inequalities in the coverage of reproductive, maternal, neonatal, and child health (RMNCH) interventions have been frequently described in global reports, but little is known about how inequalities vary across indicators in low- and middle-income countries (LMICs).

Methods
In this cross-sectional study, we identified publicly available national surveys from LMICs. We identified the most recent survey from the period 2010–19 for 36 countries containing data for our preselected set of 18 RMNCH interventions. Twenty-one countries also had information on two common malaria interventions. We classified interventions into four groups according to their predominant delivery channels: health facility-based, community-based, environmental, and culturally driven. We estimated absolute inequalities using the slope index of inequality (SII) and relative inequalities using the concentration index (CIX).

Results
We observed higher coverage levels among wealthier households than poorer households for most interventions in most countries, except for two breastfeeding indicators showing higher coverage for poor households than wealthy households. Environmental interventions were the most unequal, particularly use of clean fuels. Primarily health facility-based interventions—e.g. institutional childbirth—also usually had pro-rich patterns. By comparison, primarily community-based interventions, including those against malaria, were more equitably distributed.

Conclusions
Community-based interventions are usually more equitably distributed than health facility-based or environmental interventions. Policymakers need to learn from community delivery channels to promote more equitable access to all RMNCH interventions.

Key messages
The delivery channels framework is useful for designing equitable health policies and programmes, which must adapt the successes of community-based interventions to all RMNCH interventions.
227The use of cross-sectional series as a source of evidence for policymaker decision in Brazil
Authors: Rocha Hermano Alexandre Lima , Correia Luciano Lima , Rocha Dra Sabrina Gabriele Maia Oliveira , Leite Álvaro Jorge Madeiro , Machado Márcia Maria Tavares , Campos Jocileide Sales , Silva Anamaria Cavalcante e 
Published: September 2021

Abstract

Background
To verify the effectiveness of public policies, two or more cross-sectional studies can be carried out in series. The objective of this work is to present the maternal and child health research of Ceará (PESMIC), Brazil, a series of cross-sectional studies carried out in a partnership between the university and the local government.

Methods
PESMIC is a series of cross-sectional studies with constant methodology, a sample obtained in multiple stages, with systematic and clusters sampling, state-wide representative, which visits 8000 households in 1987, 1990, 1994, 2001, 2007 and 2017. Around 300 variables are collected, in three different questionnaires, for the home, mothers, and children.

Results
PESMIC demonstrated over 30 years the improvement of several indicators such as the drop in infant mortality from 120 to 10 per thousand, the reduction of child malnutrition from 26.8% to 8.6%, the increase in infant breastfeeding for six months from 3% to 99%, the increase in maternal literacy from 58% to 97%.

Conclusions
Over 30 years, PESMIC presented results that allowed the evaluation of public policies and the occurrence of epidemiological transitions that occurred at the population level. The use of oral rehydration serum applied by community health workers, both unprecedented in Brazil when they started in Ceará, had their effectiveness demonstrated by PESMIC and were expanded to the rest of the country soon afterward. We conclude that the transversal series are studies that can help guide decision making by public health managers.

Key messages
The use of cross-sectional series can be a feasible alternative for the formation of evidence to aid decision-making
The use of the PESMIC transversal series in Ceará helps Brazil in making important decisions such as the expansion of the community health workers program
823Suicide of welfare and care support workers: a retrospective mortality study in Australia 2001-2016
Authors: Maheen Humaira 
Published: September 2021

Abstract

Background
Emerging evidence suggests that people working in the welfare and health care industry have poorer mental health than other occupational groups; however, there has been little examination of suicide among this group. In this study, we examine suicide rates amongst welfare and care support workers and compare them to rates among human service workers, and all other occupations in Australia.

Methods
We used data from the National Coroners Information System (NCIS) to obtain records of death due to intentional self-harm between the years 2001 to 2016. We calculated age-standardised suicide rates and incident rate ratios to compare the suicide rates across different occupational groups.

Results
The age-standardised suicide rate of males is the highest amongst welfare and carers (24.1 per 100,000). After adjusting for age and year of death, we found that men working as welfare workers and carers have a significantly higher suicide rate than men working in other occupations (IRR 1.43, CI 1.2-1.7). Furthermore, male human service workers have a slightly lower rate of suicide than those working in other occupations (IRR 0.73: CI 0.66-0.82). The finding was similarly noted in female suicide deaths, however, the higher suicide rate in female welfare workers was not statistically significant (IRR 1.12 CI 0.9-1.39).

Conclusion
The suicide rates of welfare and care-related occupations are as high as occupations which are identified as at-risk occupations for male suicide in Australia.

Key message
There is a need for targeted programs to improve the suicide health literacy among welfare and care support workers.
1519Integrated Measles and Meningitis Vaccination Campaign in Nigeria: Experience of the Federal Capital Territory, Nigeria
Authors: Momoh Jenny , Zakari Furera 
Published: September 2021

Abstract

Introduction
The Nigeria government, supported by its development partners conducted several vaccination campaigns involving various antigens across the country in 2019. Majority of the states in the North including the Federal Capital Territory (FCT) implemented the Integrated Measles and Men A vaccination campaign (IVC) which itself was an innovation given that both campaigns were initially planned as stand-alone campaigns. The integration of these campaigns came with additional planning, new implementation strategies and challenges. This paper aims to highlight the key drivers of FCT’s performance in achieving greater than 90% vaccination coverage for both antigens and the challenges of the integrated campaign in FCT.

Methods
A baseline review of previous campaign reports, micro plans and tally sheet data was conducted to identify challenges of previous SIAs in FCT, best practices and lessons learnt. A preliminary analysis of available data revealed a shortfall in resources early enough in the planning phase. Notably, was a shortfall of about 300 vaccination teams for the implementation of the Measles vaccination campaign (as a standalone campaign) as well as shortfall in cold chain equipment and logistic funds. We leveraged on the thrice weekly technical coordination meetings to review these challenges to seek ways to mitigate them.

Result
Strategic efforts to address the identified gaps led to the state sponsoring an additional 354 vaccination teams to support implementation by leveraging on the SOML funds. Staggering the campaign was key to ensuring adequacy of CCEOPs to address the increase in the number required due to the integration. The additional state sponsored team vaccinated 121777 and 123588 children who otherwise would have been missed with the Measles antigen with the Men A antigen respectively.

Conclusion
Strategic resolution of identified challenges was pivotal to FCT’s performance of greater than 90% vaccination coverages for both antigens.

Key words
Measles, Meningitis A, Integrated, Vaccination, Campaign
1363Just a flu? Comparing COVID-19 and influenza mortality
Authors: Muscatello David , McIntyre Peter 
Published: September 2021

Abstract

Background
Benchmarks are needed for assessing the severity of the COVID-19 pandemic. However, comparisons can be misleading unless marked differences in age-specific mortality and differences in population age structure are considered.

Methods
Using COVID-19 death rates for New York City as at 2 June 2020, we used indirect age standardization to estimate standardized mortality ratios (SMR) for the first winter waves of the 1918 and 2009 influenza pandemics and the severe 2017-2018 influenza season in the United States (US). Data were obtained from published statistics.

Results
After adjusting for age, New York City’s death rate during the 1918 winter influenza pandemic wave was 6.7 times higher overall compared with the first wave of COVID-19 in 2020. New York City's first wave COVID-19 death rate was an estimated 59 times higher than that of the 2009 US influenza pandemic, and 14 times higher than that of the severe 2017-2018 influenza season. In &lt; 45 year-olds, the 1918 influenza death rate was 42 times higher than COVID-19 in 2020. In ≥ 65 year-olds, compared with the 2009 pandemic, the COVID-19 death rate was 320 times higher, while in children it was one half.

Conclusions
The 1918 pandemic was more deadly than COVID-19, which was, in turn, far more deadly than both the 2009 influenza pandemic and severe seasonal influenza. Age-specific mortality differences should be considered in decisions on COVID-19 vaccination strategies.

Key messages
Fundamental epidemiological methods remain valuable for modern epidemic risk assessment. COVID-19 is not just a ‘flu’.
1333Economic impact of salt-reduction policies in Japan, 2019–2028: a Markov model simulation analysis
Authors: Nishi Nobuo , Kato Hiroki , Ikeda Nayu 
Published: September 2021

Abstract

Background
The economic impact of nutritional policies has been rarely evaluated in Japan. We aimed to assess costs and benefits of salt-reduction policies for cardiovascular disease prevention.

Methods
We conducted a cost-benefit analysis using a Markov cohort simulation model over the period 2019 to 2028. We compared two salt-reduction policies—a national media campaign to promote healthy eating and physical activity (Policy A), and voluntary reformulation by the food industry to reduce salt added in processed food (Policy B). We used epidemiological data in Japan from national surveys and a global database, and estimates from previous meta-analyses on the changes in cardiovascular incidence and mortality associated with salt reduction. We applied a costing method in a previous study in England. We estimated benefits as a decrease in medical costs associated with cardiovascular diseases and costs as the sum of monitoring costs, policy costs, and subsidies.

Results
The estimated net benefits were 66.6 billion yen for Policy A and 353.5 billion yen for Policy B, and the latter was dominant. However, Policy A became dominant when the annual subsidy for Policy B exceeded 43.7 billion yen.

Conclusions
We employed a Markov cohort simulation by partially applying Japanese data to evaluate salt-reduction policies. In future research, it is necessary to collect data on salt reduction estimates and policy costs in Japan.

Key messages
As salt-reduction policies, voluntary food reformulation will be more beneficial than the media campaign as far as the annual subsidy does not exceed one-eighth of the benefit.
1167Disease Burden and Universal Health Coverage Monitoring
Authors: Okamoto Shohei , Shimmmei Keita , Okamura Tomonori 
Published: September 2021

Abstract

Background
Achieving universal health coverage (UHC) is a target of the Sustainable Development Goals, and the monitoring of its progress is of use to clarify what to be enhanced for better health. While the WHO and the World Bank Group jointly developed a scale with the above purpose (WHO/WB index: Hogan et al., 2018), it fails to reflect the fact that different needs to health coverages may exist depending on a stage of epidemiological transition.

Methods
To consider potential differences in health coverage needs depending on the stage of the epidemiological transition, we reformulated the index by incorporating weight as the proportion of age-adjusted mortality rate among monitored domains (i.e. reproductive, maternal, new-born and child health, infectious disease, non-communicable diseases [NCD]), of which data collected from the WHO Global Health Observatory. Additionally, we utilised indicators of policy achievements on NCD by the WHO’s Noncommunicable Diseases Progress Monitor 2015.

Results
The UHC progress monitored by the WHO/WB index had a mean of 61.83 (%) while it declined by about 4% point on average when NCD indicators were replaced. Furthermore, the UHC progresses evaluated with weights calculated from disease burden decreased by about 10% point for both measures, suggesting that some countries may not provide demanded health coverages.

Conclusion
The UHC progress decreased when disease burden for each country was taken into consideration. This indicates the necessity to assess the UHC progressby reflecting disease structure of each country, not by an identical scale for all nations.

Key messages
The monitoring of universal health coverage is required to reflect disease structure of each country.
940Physical frailty and the onset of depressive symptom in older Japanese women
Authors: Sasai Hiroyuki , Kojima Narumi , Osuka Yosuke , Kim Hunkyung 
Published: September 2021

Abstract

Background
The co-occurrence of physical frailty and depressive symptoms is highly prevalent in late life. However, their causal direction remains unclear. This study examined whether frailty and its components (slowness, weakness, exhaustion, low activity, and weight loss) predict the onset of depressive symptoms among older Japanese women.

Methods
In a two-year cohort study conducted in a metropolitan area of Tokyo, we collected baseline data in October 2017 and follow-up data in September 2019. Participants were community-dwelling older Japanese women, aged 65 to 80 years without any neurological diseases or depressive symptoms. Logistic regression analyses were applied to estimate odds ratios (OR) of the onset of depressive symptoms (15-item Geriatric Depression Scale [GDS] score ≥ 6) across the baseline frailty status or its components classified by the Japanese version of Cardiovascular Health Study criteria.

Results
Of the 477 women analysed (275 robust and 202 prefrail/frail). 6 (2.2%) robust and 16 (7.9%) prefrail or frail women developed depressive symptoms. After being adjusted for various covariates including baseline GDS score, the OR of the depressive symptom onset was 3.04 (95% confidence interval [CI]: 0.99, 10.47) in the prefrail or frail women. Among the five frailty components, slowness (OR: 7.55, 95%CI: 1.11, 48.98) and exhaustion (OR: 5.00, 95%CI: 1.60, 16.13) were independently associated with the onset of depressive symptoms.

Conclusions
Physical frailty status, particularly slowness and exhaustion, predict future depressive symptoms in older women.

Key messages
Early detection and intervention targeting physical frailty may help prevent depressive symptoms in later life.
289Birthweight and risks of adult-onset diabetes in women who are and are not overweight
Authors: Shawon Shajedur Rahman , Yang TienYu Owen , Floud Sarah , Green Jane , Reeves Gill , Beral Dame Valerie 
Published: September 2021

Abstract

Background
Higher adult body mass index (BMI) increases diabetes risk, whereas, paradoxically, lower birthweight is associated with higher risks of adult-onset diabetes. Increased diabetes risks associated with low birthweight might be due to increased risks among those who become overweight or obese as adults but evidence on risks among those of normal BMI is limited.

Methods
In the Million Women Study, 413,516 women without prior diabetes, at mean age 60(SD5) years, reported their birthweight, and current height and weight. Birthweight and BMI at age 60 years were validated against recorded values at similar ages. Participants were followed for diabetes by electronic linkage to national hospital admissions records. Cox regression yielded multivariable-adjusted relative risks (RRs) for diabetes, overall and subdivided simultaneously by categories of birthweight and adult BMI.

Results
During 15(SD3) years follow-up, 24,528 women had hospital admissions with diabetes, first recorded at average age 70(SD6) years. Adult-onset diabetes risks increased strongly with increasing adult BMI (RR per 5 kg/m2 increase: 2.03, 95% CI 2.01-2.06). Compared to those with birthweight 3.0-3.4 kg, RRs of diabetes for birthweight &lt;2.5 kg and ≥4.0 kg were 1.35(1.30-1.38) and 0.73(0.70-0.75), respectively. The association between low birthweight and increased diabetes risk was strongly evident among women who were of normal BMI, overweight and obese (p &lt; 0.0001 for each).

Conclusions
At every level of adult adiposity, there were strong inverse associations between birthweight and adult-onset diabetes risk.

Key messages
While adult adiposity increases diabetes risk, there is a strong and independent increase in diabetes risk with decreasing birthweight.
1298Associations of DMT therapies with COVID-19 severity in multiple sclerosis
Authors: Simpson-Yap Steve , Brouwer Edward De , Kalincik Tomas , Rijke Nick , Hillert Jan , Walton Clare , Edan Gilles , Spelman Tim , Geyes Lotte , Parciak Tina , Gautrais Clément , Lazovski Nikola , Pirmani Ashkan , Ardeshirdavani Amin , Forsberg Lars , Glaser Anna , McBurney Robert , Schmidt Hollie , Bergmann Arnfin , Braune Stefan , Stahmann Alexander , Middleton Rodden , Salter Amber , Fox Robert , van der Walt Anneke , Butzkueven Helmut , Rojas Juan , van der Mei Ingrid , Nag Nupur , Ivanov Rumen , Olival Guilherme Sciascia do , Dias Alice Estavo , Magyari Melinda , Brum Doralina Guimarães , Mendes Maria Fernandes , Alonso Ricardo , Nicholas Richard , Bauer Johana , Chertcoff Anibal , Zabalza Ana , Arrambide Georgina , Fidao Alexander , Comi Giancarlo , Peeters Liesbet 
Published: September 2021

Abstract

Background
People with multiple sclerosis (MS) are a vulnerable group for severe COVID-19, particularly those taking immunosuppressive disease-modifying therapies (DMTs). We examined the characteristics of COVID-19 severity in an international sample of people with MS.

Methods
Data from 12 data-sources in 28 countries were aggregated (sources could include patients from 1-12 countries). Demographic (age, sex), clinical (MS phenotype, disability), and DMT (untreated, alemtuzumab, cladribine, dimethyl-fumarate, glatiramer-acetate, interferon, natalizumab, ocrelizumab, rituximab, siponimod, other) covariates were queried, alongside COVID-19 hospitalisation, admission to ICU, requiring artificial ventilation, and death. Characteristics of outcomes were assessed in patients with suspected/confirmed COVID-19 using multilevel mixed-effects logistic regression, adjusted for age, sex, MS phenotype, and EDSS.

Results
657 (28.1%) with suspected and 1,683 (61.9%) with confirmed COVID-19 were analysed. Among suspected+confirmed/confirmed-only COVID-19, 20.9%/26.9% were hospitalised, 5.4%/7.2% were admitted to ICU, 4.1%/5.4% required artificial ventilation, and 3.2%/3.9% died. Older age, progressive MS-phenotype, and higher disability were associated with worse COVID-19 outcomes. Compared to dimethyl-fumarate, ocrelizumab and rituximab were associated with hospitalisation (aOR=1.56,95%CI=1.01-2.41; aOR=2.43,95%CI=1.48-4.02) and ICU admission (aOR=2.30,95%CI=0.98-5.39; aOR=3.93,95%CI=1.56-9.89), though only rituximab was associated with higher risk of artificial ventilation (aOR=4.00,95%CI=1.54-10.39). Importantly, associations persisted on restriction to confirmed COVID-19 cases. No associations were observed between DMTs and death.

Conclusions
Despite the cross-sectional design of this study, the internal and external consistency of these results with prior studies suggests their use may be a risk factor for more severe COVID-19.

Key messages
Anti-CD20 DMTs may be associated with worse COVID-19 severity amongst people with multiple sclerosis.