bluuebunny/crossref_metadata_2025_split huggingface dataset:
1116Spatial diffusion of the 2015-2016 Zika, dengue, and chikungunya epidemics in Rio de Janeiro, Brazil
Authors: Dalvi Ana Paula Razal , Braga Jose 
Published: September 2021

Abstract

Background
Text: Different countries, especially Brazil, that have faced recurrent dengue epidemics for decades and chikungunya epidemics since 2014, have had to restructure their health services to combat a triple epidemic of arboviruses - Zika, dengue, and Chikungunya - transmitted by the same vector, mainly Aedes aegypti, in 2015-2016. Several efforts have been made to better understand these three arboviruses. The knowledge of the patterns of spatial diffusion of diseases during an epidemic can contribute to the planning of surveillance actions and control of these diseases. This study aimed to identify spatial diffusion processes of these viruses in the context of the triple epidemic in 2015-2016 in Rio de Janeiro, Brazil.

Methods
Text: Two study designs were used: cross-sectional and ecological. Zika, dengue, and chikungunya cases notified to the national notificable disease surveillance system of the Ministry of Health of Brazil in 2015 and 2016 were used. The residential addresses of the cases were geocoded. Sequential Kernel maps, nearest-neighbor ratios calculated cumulatively over time, Moran global autocorrelation correlograms, and local autocorrelation changes over time were used to identify spatial diffusion patterns.

Results
Text: Our findings suggest an expansion diffusion pattern for the 2015-2016 triple epidemic of Zika, dengue and chikungunya in the city of Rio de Janeiro, Brazil, as well as the sites most affected by the diseases.

Conclusions
Text: The spatial diffusion pattern of expansion was suggested by the results of the spatial analysis used.

Key messages
Text: These findings can be considered for more effective control measures and for new studies on the dynamics of these three arboviruses.
1441Indirect effects of COVID-19 in Australia during 2020
Authors: Reynolds Anna , Moon Lynelle , Gourley Michelle 
Published: September 2021

Abstract

Focus of Presentation
COVID-19 is a major health threat that has led to substantial disruption to almost all parts of society worldwide. We brought together available data to assess the impact of the first 12 months of COVID-19 in Australia, examining initial data on the indirect effects of the pandemic on Australian’s health and welfare.

Findings
During 2020, Australia recorded lower than expected total mortality, in contrast to many other countries where excess mortality (higher than expected deaths) was observed. Age-standardised death rates for influenza and pneumonia, and chronic lower respiratory infections during both waves of COVID-19 cases were lower than in previous years. The initial impacts of the epidemic in Australia appear to have increased levels of psychological distress. However, the number of deaths by suicide in NSW, Victoria and Queensland have remained at similar levels to previous years. Important health behaviours, such as physical activity and alcohol consumption, worsened for some people but improved for others. The travel restrictions appear to have caused a reduction in injuries due to falls and road traffic accidents, particularly during the first lockdown in March-April 2020.

Conclusions/Implications
Public health measures introduced to control the spread of COVID-19 in Australia had both positive and negative health effects. The impact of these effects will need to be monitored over time.

Key messages
The indirect effects of COVID-19 in Australia are wide-ranging and include impacts on mental health, health behaviours and deaths from other diseases.
1466Vitamin D status before, during and after treatment and ovarian cancer survival
Authors: Ross Tanya , Webb Penny , Neale Rachel 
Published: September 2021

Abstract

Background
Previous work found higher serum 25-hydroxyvitamin D (25(OH)D) [circulating form of vitamin D] concentrations at diagnosis were associated with longer survival in patients with ovarian cancer (OvCa). There was no evidence for an association with 25(OH)D after primary treatment, but power was limited. Our aim was to reassess this association in a larger sample, including measures collected during treatment and using techniques to deseasonalise 25(OH)D.

Methods
Participants were diagnosed between 2002-2006 and 2012-2015 from the Australian Ovarian Cancer Study (AOCS) and the Ovarian Cancer, Prognosis and Lifestyle (OPAL) study, respectively. 25(OH)D concentrations were available for 676 at diagnosis (AOCS), 805 during treatment (AOCS:208; OPAL:597) and 861 after completion of primary treatment and before recurrence (AOCS:342; OPAL:519); 1006 AOCS samples were included in the previous analysis. Sociodemographic, diet and lifestyle data came from questionnaires self-completed at recruitment, and clinical/survival data from medical records, supplemented with National Death Index linkage. We will use Cox regression and non-parametric models to examine associations with survival.

Results
Median 25(OH)D concentrations were lowest during treatment, intermediate at diagnosis and highest after treatment (AOCS 51, 64, and 71 nmol/L, respectively). 5-year survival was 50% in AOCS and 59% in OPAL. Updated survival results will be presented.

Conclusions
If the association is confirmed in this updated analysis, then increasing vitamin D concentrations may provide a way to improve survival following OvCa.

Key messages
Higher circulating vitamin D concentrations may improve survival in OvCa.
1067Annual changes in job strain and risk of coronary heart disease in Denmark
Authors: Sørensen Jeppe Karl , Framke Elisabeth , Madsen Ida E.H. , Rugulies Reiner 
Published: September 2021

Abstract

Background
We examined the association between annual changes in job strain and incident coronary heart disease (CHD) in a population-based cohort study in Denmark.

Methods
We studied all workers residing in Denmark in 2000, aged 30-59 years with no prevalent CHD (N = 1,660,150). Using a job exposure matrix (JEM) with annual updates, we assessed changes in job strain from 2000-2009. Incident CHD was identified in hospital and death registers from 2001 to 2010. Using Cox regression, we calculated hazard ratios (HR) and 95% confidence intervals (CI) for the association between annual changes in job strain and incident CHD.

Results
During 16.1 million person-years (mean time of follow-up: 9.7 years), we identified 24,159 CHD cases (15.0 per 10,000 person-years). Compared to persistent no job strain, persistent job strain (HR 1.07, 95% CI 1.03–1.10), onset of job strain (HR 1.20, 95% CI 1.12–1.29) and removal of job strain (HR 1.20, 95% CI 1.12–1.28) were associated with higher CHD incidence.

Conclusions
Persistent and onset of job strain was associated with a higher risk of CHD. Removal of job strain was also associated with a higher risk, which might be due to health selection. Our results suggest that job strain contributes to risk of CHD in the Danish workforce.

Key messages
Implementing JEM in a population-based cohort of more than 1.6 million workers enabled us to demonstrate associations between annual changes in job strain and risk of incident CHD.
197Assessment of Depression, Anxiety and Fatigue in relation to diet quality in Multiple Sclerosis
Authors: Saul Alice , Taylor Bruce , Simpson Steve , Oddy Wendy , van der Mei Ingrid 
Published: September 2021

Abstract

Background
Many people with multiple sclerosis (MS) modify their dietary intake, but there is low evidence that this influences MS disease activity or progression. We examined whether indices of diet quality (Dietary Quality Tracker and Australian Recommended Food Score) were associated with depression, anxiety and fatigue using a prospective cohort.

Methods
The Auslong Study participants were followed annually for 10 years (n = 223 with MS at 10 years). Depression & anxiety (Hospital Anxiety & Depression Scale, HADS) and fatigue (Fatigue Severity Scale) were assessed at the 5th and 10th-year reviews. Dietary intake in the preceding 12 months using the Cancer Council Victoria Food Frequency Questionnaire was assessed at the baseline, 5th and 10th year reviews.

Results
Overall diet quality at the 5th-year review was not associated with a change in depression, anxiety or fatigue in the subsequent 5 years. However, a higher intake of protein, grain and discretionary foods at the 5th-year review using the Dietary Quality Tracker were associated with an increase in HADS depression score over the subsequent 5 years (e.g. highest vs lowest quartile protein: β=2.14,95%CI=0.91,3.37,p&lt;0.001). Also, a higher legume intake at the 5th-year review was associated with a decrease in HADS anxiety score over the subsequent 5 years( e.g. highest vs lowest quartile: β=-1.92,95%CI=-3.32,-0.53,p=0.01).

Conclusion
Overall diet quality was not associated with a subsequent change in depression, anxiety or fatigue over 5-years but some specific food groups were associated with depression and anxiety. Replication is required before testing these findings with diet intervention programs in people with MS.

Key messages
Overall diet quality was not associated with 5-year change in depression, anxiety and fatigue in people with MS. However, some individual food groups were associated with a change in depression and anxiety.
523Use of beta blockers and death from breast cancer in New Zealand breast cancer patients
Authors: Scott Oliver , TinTin Sandar , Cavadino Alana , Elwood Mark 
Published: September 2021

Abstract

Background
Beta blockers (BB), used for a range of cardiovascular indications, have been associated with improved, worsened, and unchanged breast cancer outcomes in previous studies. This study examines the association between the use of BBs and death from breast cancer in a large, representative sample of New Zealand women.

Methods
Women diagnosed with a first primary breast cancer between 2007 and 2016 were identified from four population-based regional NZ breast cancer registries and linked to pharmaceutical data, hospital discharges, and death records. The median follow up time was 4.51 years. Cox proportional hazard models were used to assess the hazard of breast cancer specific death (BCD) associated with post-diagnostic BB use.

Results
Of the 14,976 women included in analysis, 21% used a BB after diagnosis. Although not significant, beta blocker use increased the risk of BCD (adjusted hazard ratio: 1.08; 95% CI: 0.93-1.26). The increased risk was seen only in those with at least one cardiac condition, and was also reduced by lagging the exposure, suggesting effects of BB use close to the end of life. The increased risk was also confined to short term use (0-3 months). BB use for more than 1 year was associated with a decreased risk of BCD, and the risk steadily decreased to HR 0.53 (95% CI: 0.33-0.85) for use for 3+ years.

Conclusions
Any increased risk associated with BB use is likely to be due to a combination of confounding by indication and short-term use. Long-term BB use may confer some protection for BCD.

Key messages
The effect of beta blockers is difficult to separate from the indications for the drug. While there was no significant overall effect, there was a suggestion that beta blockers may be protective for breast cancer death with long-term exposure.
1523Early political actions on education and healthcare sectors against COVID-19 in five Latin American countries
Authors: Gómez Arley , Segura Omar , Villamizar Licet , Rivera Diana , Niño Levinson , Bejarano Diego 
Published: September 2021

Abstract

Background
The first Latin-American COVID-19 case was reported in Brazil on February 26, 2020; since then, all regional governments tried to set-up sanitary measures to avoid COVID19 and lower mortality rates among susceptible population. Main goal here is to describe early political decisions and actions on education and healthcare against COVID-19 in five regional countries.

Methods
Qualitative study based upon intersectoral policy content analysis of bills, plans, and ministry-level documents issued in Argentina, Chile, Brazil, Colombia and Ecuador during February – April 2020; political actions and social reactions as depicted in broad news agencies (CNN, DW) were considered also. Analysis was categorized by three document levels (government, corporate, news), two dimensions (education, healthcare), five measures (quarantine, curfews, social distancing; hands washout, face mask). PDF/DOC/DOCX files were downloaded from their respective webpages, compiled in Google Drive, and analyzed to obtain both emergent categories and compacted texts for integration in a narrative way.

Results
Emerging categories included political/legal context, rationale, choice of approach against COVID-19, timeline, recurring concepts. Healthcare and education reflected citizens’ perception, states’ strength, and reactive/proactive congressional or ministerial responses. Lack of preventive measures - laboratory tests, low to none contacts’ follow-up, insufficient vaccines/biological products development, and failure in long-term education or science programs triggered a negative cascade effect.

Conclusions
Depending on each country, there was either compromise on social science to bolster executive management or negation, political polarization, and corruption/corruption of state structures; these issues are complex demanding long-term inter/transdisciplinary approaches solutions against a new pandemic in the future.

Key messages
Social and political structures and organization have had direct incidence in national response to COVID-19 pandemic.
In Latin America, long term research in both health and education is required facing a future new pandemic.
884Data sharing willingness and attitudes
Authors: Seidler Anna Lene , Tan Aidan , Hunter Kylie E , Barba Angie , Askie Lisa 
Published: September 2021

Abstract

Background
Row-by-row individual participant data (IPD) from a set of similar studies allows meta-analyses with exposure, confounder and outcome standardisation, and additional analyses at little extra cost. The ICMJE recently declared data sharing an ethical obligation. Consequently, registries have introduced mandatory data sharing statements. Our aims were to analyse data sharing willingness, and identify barriers and facilitators to data sharing.

Methods
We included all trials registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) in 2019. We analysed data sharing statements from registry records, and conducted an in-depth survey. Associations between willingness to share data and trial characteristics (e.g. trial purpose, funding) were analysed.

Results
Of the 1,517 included trials, 23% planned to share IPD upon completion. Investigators were less willing to share IPD for industry-funded trials (OR = 0.50,95%CI=0.34-0.70), but there was no difference by sample size or health condition. The main reasons for not sharing IPD were concerns about participant privacy (22%), ethics approval limitations (19%) and lack of understanding for the need of IPD (17%). Among the 281 survey respondents, 78% supported data sharing, but only 40% intended to share their data. Major barriers included concerns about time/resources (96%) and insufficient academic recognition (91%).

Conclusions
There is insufficient willingness to share data, particularly among industry funders. Addressing the identified barriers can improve this.

Key messages
Data sharing enables the use of new methodologies, such as improved meta-analysis. Low willingness to share data jeopardises the use of these new methodologies and needs to be addressed.
919Step-by-step guidance on prospective meta-analyses
Authors: Seidler Anna Lene , Hunter Kylie , Cheyne Saskia , Berlin Jesse , Ghersi Davina , Askie Lisa 
Published: September 2021

Abstract

Focus of Presentation
In a prospective meta-analysis (PMA), studies are included before their results are known. This can reduce risk of publication bias and selective outcome reporting, and enables researchers to harmonise their research efforts. Despite rising numbers, there is little guidance on how to conduct PMA. We, the Cochrane PMA Methods Group, developed step-by-step guidance based on a scoping review, and expert opinions and experiences. Each step is illustrated with a recent case study.

Findings
We describe seven steps for conducting PMA. After developing a protocol (Steps 1), a systematic search for eligible planned/ongoing studies should be conducted, including a search of registries, medical databases and contacting stakeholders (Step 2-3). These studies are then invited to form a collaboration (Step 4), ideally including a steering and data analysis committee. Next, important study features such as common core outcomes and confounders are agreed upon (Step 5). This reduces heterogeneity and increases the number of available outcomes for meta-analysis. Certainty of evidence is assessed by adapting tools such as GRADE (Step 6). Results should be reported using adapted versions of reporting tools such as PRISMA (Step 7).

Conclusions/Implications
PMA reduce many problems of traditional retrospective systematic reviews and meta-analysis. Updated guidance and recent technical advances will help increase their numbers further.

Key messages
PMA are ‘next generation systematic reviews’ that allow for greatly improved use of data, whilst reducing bias and research waste. This step-by-step guidance will enable more researchers to conduct successful PMA.
178Depression but not physical activity mediates the fatigue-mental quality of life relationship in multiple sclerosis
Authors: Fidao Alexander , De Livera Alysha , Weiland Tracey , Jelinek George , Neate Sandra , Nag Nupur , Simpson-Yap Steve 
Published: September 2021

Abstract

Background
Fatigue is among the most prevalent symptoms of multiple sclerosis (MS), and significantly detrimental to mental quality of life. We examined the role of depression and physical activity as mediators in the fatigue-QoL relationship in MS.

Methods
Using an international study cohort measuring a wide range of lifestyle and clinical factors, determinants of fatigue (Fatigue Severity Scale) and mental quality of life (MSQoL-54; QoL) were assessed in 2,104 participants using log-binomial and linear regression, respectively. Structural equation modelling (SEM) was used to assess the mediating role of depression and physical activity between fatigue and mental QoL.

Results
The median mental QoL score in the sample was 73.8/100. The mean fatigue score was 40.5/63, with 65.6% having clinically significant fatigue. In SEM analyses evaluating depression as a mediator of the fatigue-QoL relationship, mental QoL was 14.17-points lower in those with clinically significant fatigue, of which the indirect effect via depression accounted for over 30.8% (p &lt; 0.001). This mediation effect was most pronounced for the Role Limitations from Emotional Issues (44.9%, p &lt; 0.001) and Emotional Wellbeing (41.6%, p &lt; 0.001) subdomains. Evaluating physical activity as a mediator of the fatigue-QoL relationship, mental QoL was 11.03-points lower in those with clinically significant fatigue, of which the indirect effect via physical activity accounted for only 1.0% (p = 0.001).

Conclusions
This study provides evidence that depression accounts for a majority of the fatigue-mental QoL relationship, while physical activity only plays a small role. While replication and longitudinal studies are required for validation, our findings may inform the development of treatments for reducing the impacts of fatigue and improving QoL in people with MS.

Key messages
Fatigue’s negative impact on emotional quality of life in multiple sclerosis is not a function of reduced ambulation but instead its impact on depression. Reducing depression may thus markedly improve quality of life in this population.
100Identification of a latitude gradient in the prevalence of Primary Biliary Cholangitis in Australia
Authors: French Janine , Simpson-Yap Steve , Ng Justin , Angus Peter , van der Mei Ingrid , Gow Paul 
Published: September 2021

Abstract

Background
Primary biliary cholangitis (PBC) is an autoimmune destructive condition of the gall bladder, with environmental factors like sun exposure implicated in its aetiology, similar to multiple sclerosis. PBC prevalence varies significantly and appears to have a positive latitudinal gradient. To determine whether there was a latitudinal gradient of PBC prevalence in Australia using two methods of prevalence estimation: private pathology anti-mitochondrial antibody (AMA) results, the primary diagnostic test for PBC, and ursodeoxycholic acid (UDCA) prescriptions, the sole pharmacological treatment for PBC.

Methods
We investigated the latitudinal variation in PBC prevalence across the states and territories of Australia (latitudinal range 18.0° to 42.7°S) using pathology-based (private pathology AMA results search (three of the major private pathology companies in Australia which cover 77% of all private pathology testing) and PBC-specific prescription databases (prescriptions for UDCA).

Results
Pathology-based PBC prevalence was significantly increased with latitude, such that the postcodes in the highest quintile of latitude (encompassing the south coastal areas of the Australian mainland and insular Tasmania (latitude range -37.75 to -42.72)) had 1.83-times higher frequencies than those in the lowest quintile (encompassing tropical and southern Queensland (latitude range -18.02 to -27.59). Analogous results were seen for state-based UDCA prescriptions, being 2.31-times higher in Tasmania than Queensland.

Conclusions
We have found for the first time that the prevalence of PBC significantly varies with latitude in Australia. While the most immediate mediating factors underlying this association would be ultraviolet radiation and vitamin D levels, studies to substantiate this mechanism are needed.

Key messages
In line with some other autoimmune conditions, PBC shows a significant positive latitudinal gradient, with nearly 2-times higher prevalence in the southernmost state than the northernmost.
101Pre-onset sun exposure significantly associated with risk of primary biliary cirrhosis
Authors: French Janine , Simpson-Yap Steve , Ng Justin , Angus Peter , van der Mei Ingrid , Gow Paul 
Published: September 2021

Abstract

Background
Primary biliary cholangitis (PBC) is an autoimmune destructive condition of the gall bladder, with environmental factors like sun exposure implicated in its aetiology, similar to multiple sclerosis. Using a case-control study design, we assessed sun exposure across the life course prior to PBC diagnosis between PBC cases and age/sex-matched healthy controls.

Methods
Cases with definite/probable PBC were recruited, these having been identified from a PBC prevalence study. Age/sex matched controls were recruited from the electoral roll or at the Austin Hospital. Pre-onset sun exposure behaviours were queried at baseline by questionnaire and life calendar, this combined with ambient UVR data to estimate total UVR load. Relationships with case status were assessed using conditional logistic regression.

Results
200 cases and 200 age/sex-matched controls were recruited. 91% of the cases were female and the mean age was 63.6 years. Increasing sun exposure was associated with significantly lower odds of being a case, robust to adjustment for birthplace, education and smoking, the strongest associations seen for summer exposure in 6-10yo (OR = 0.39), 11-16yo (OR = 0.44), and 16-20yo (OR = 0.47). Similar results were seen for ambient UVR.

Conclusions
Higher pre-onset sun exposure and UVR load were associated with a decreased risk of primary biliary cholangitis. This is the first study that has examined the environmental risk factors of sun exposure and UV radiation with regard to PBC.

Key messages
In line with the observation of a significant latitudinal gradient in PBC prevalence, this work shows that pre-onset sun exposure is significantly lower among PBC cases compared to matched controls, suggesting sun exposure has an aetiological relationship with PBC risk.