bluuebunny/crossref_metadata_2025_split huggingface dataset:
232The Impact of Australasian Voluntary Front of Pack Nutrition Labelling on Packaged Food Reformulation
Authors: Bablani Laxman , Mhurchu Cliona Ni , Neal Bruce , Skeels Christopher , Staub Kevin , Blakely Tony 
Published: September 2021

Abstract

Background
Front-of-pack nutrition labelling (FoPL) of packaged foods can promote healthier diets. Australia & New Zealand (NZ) adopted the voluntary Health Star Rating (HSR) scheme in 2014. We studied the impact of voluntary adoption of HSR on food reformulation overall, and for more- versus less-healthy foods.

Methods
Annual nutrition information panel data was collected for non-seasonal packaged foods sold in major supermarkets in Auckland from 2013-19, and Sydney from 2014-18. We used difference-in-differences to estimate reformulation associated with HSR adoption.

Results
Healthier products adopted HSR more than unhealthy products: 35% of products that achieved four or more stars displayed the label compared to 15% of products that achieved two stars or less. Products that adopted HSR were 6.5% & 10.7% more likely to increase their rating by ≥ 0.5 stars in Australia and NZ, respectively. Labelled products showed a -4.2% [95% CI -6.5% to -1.9%] relative decline in sodium content in NZ, but there was no sodium change in Australia. There was a -2.3% [-3.7% to -1.0 %] change in sugar content in NZ and a -1.1% [-2.2% to 0.0%] difference in Australia. Initially unhealthy products showed larger reformulation when adopting HSR than healthier products.

Conclusions
Overall, introduction of HSR had a small effect on product reformulation. The voluntary nature of the HSR program lowers effectiveness because labels were mostly placed on already healthy products. These already healthy products had limited scope for reformulation.

Key messages
HSR adoption by unhealthy products should be incentivized, or mandated, by governments to maximise reformulation
437Comparison of stillbirth trends in Wales and Western Australia using pooled routinely collected health data
Authors: Bailey Helen , Kotecha Sarah J , Watkins William J , Adane Akilew , Shepherd Carrington CJ , Kotecha Sailesh 
Published: September 2021

Abstract

Background
As there are variations in stillbirth rates and trends, even among high income countries, international comparisons can provide insights into how reductions in stillbirths can be achieved. We compared stillbirth rates and trends over time in Wales and Western Australia (WA).

Methods
We pooled population-based data of all births of at least 24 weeks’ gestation occurring between 1993-2015 in Wales and WA, divided into 6 time-periods. The stillbirth rate per 1,000 births was estimated for each cohort in each time-period. Multivariable Poisson regression analyses, were performed to evaluate the interaction between cohort and time-period. relative risk (RRs) and 95% Confidence Intervals (CIs) for each time-period and cohort were calculated.

Results
The overall stillbirth rate declined by 15.9% in Wales and 40.4% in WA. Using WA and 1993-1996 as the reference group, the adjusted RRs for stillbirths at 39-41 weeks’ gestation in the most recent study period (2013-15) were 0.85 (95% CI 0.64 to 1.13) in Wales and 0.51 (95% CI 0.36 to 0.73) in WA.

Conclusions
The stillbirth rate disparities between Wales and WA have widened in the last two decades (especially among term births). Some of these differences may be partially explained by maternal lifestyle behaviours such as smoking, but we had insufficient population-level data to investigate their contribution.

Key messages
The stillbirth rate was persistently higher in Wales than WA from 1993 to 2015, with widening disparities after adjustment for important risk factors.
637Validation of anaemia, haemorrhage and blood disorder reporting in routinely collected hospital data
Authors: Baldwin Heather , Torvaldsen Siranda , Rickard Kristen , Nippita Tanya , Patterson Jillian 
Published: September 2021

Abstract

Background
Blood and bleeding related conditions are reported in hospital administrative data, however the reliability of these data is unknown. Here we examine the reliability of reporting of conditions including anaemia, obstetric haemorrhage and blood disorders, and procedures, such as transfusion and hysterectomy, in hospital records compared with obstetric databases.

Methods
Women giving birth to singleton infants in two tertiary hospitals in New South Wales, Australia, between 2011 and 2015 were included. Reporting in the hospital data, drawn from the Electronic Medical Records, was compared to that in linked obstetric data, obtained from the ObstetriX system, using obstetric data as the gold standard.

Results
36,051 births were included. Sensitivity for anaemia and blood disorders was low (2.5–24.8%, positive predictive value (PPV) 12.0–82.6%), high for postpartum haemorrhage, transfusion and hysterectomy (82.8–96.0%, PPV 78.0–89.6%), and moderate for other obstetric haemorrhage (sensitivity: 41.9–65.1%, PPV: 50.0–56.8%) and placental complications (sensitivity 68.2–81.3%, PPV: 20.3–72.3%). Specificity and negative predictive values were high.

Conclusions
Anaemia and blood disorders are poorly reported in hospital data. Postpartum haemorrhage, transfusion and hysterectomy are well reported, while other obstetric haemorrhage and placental complications are moderately well reported.

Key messages
Hospital data may be a reliable source of information on postpartum haemorrhage, blood transfusion and hysterectomy. Caution is advised in the use of hospital data for studies of anaemia and blood disorders, and other sources should be sought where possible.
492Determinants of mother to child transmission of HIV in West Shewa, Oromiya: Mixed-method study
Authors: Banja Fufa 
Published: September 2021

Abstract

Background
Without intervention, transmission rate of HIV from mother to child ranges from 15% to 45%, that can be reduced to below 5% with effective intervention. In West Shewa zone transmission rate is 10% currently. Aim of the study is to identify determinants of transmission of HIV from mother to child in West Shewa Zone which has 2.1 million populations.

Methods
Mixed methods: unmatched case-control study, N = 96(24 cases, 72 controls) and one-on-one questioner was conducted. Variables of interest were collected using structured and semi-structured questioner and data abstraction forms from mothers of exposed infants, medical records of mothers and children.

Result
Majority among cases(70.8%) were not included in to option B+ program. Home delivery increases 6 times chance of HIV, AOR=6.047, CI(1.549–29.230), none inclusion in to option B+ increase 18 chance of HIV transmission, AOR=18.0;CI(5.0–68.1). Partner noninvolvement to HIV care increases chance of transmission by 7.3 times, AOR=7.3;CI(1.14–37.459). Mother- mother support program decrease chance of transmission by 86.5% with AOR=0.135CI (0.11–0.396). Poor ANC practices among rural residents contributed to unaware MTCT of HIV.

Conclusion
Mother-to-mother support program has protective effect, while None inclusion to option B+, partner noninvolvement to HIV care, Home delivery and poor ANC practice were determinant factors of HIV transmission from mother to child.

Key messages
Health education and awareness creation should be implemented by HEW to improve ANC practice, and increase VCT among rural residents.
923Quantifying multiple causes of death: Observed patterns in Australia, 2006–2017
Authors: Bishop Karen , Balogun Saliu , Eynston-Hinkins James , Moran Lauren , Moreno-Betancur Margarita , Korda Rosemary , Rao Chalapati , Banks Emily , Joshy Grace 
Published: September 2021

Abstract

Background
Four fifths of deaths in Australia involve multiple causes, but statistics typically use a single underlying cause of death (UC). The UC approach alone is insufficient for understanding the impact of non-underlying causes and identifying comorbid disease associations at death. Analysis of multiple causes of death (MC) is needed to measure the impact of all causes. We described MC patterns, considering cause-of-death coding and certification practices in Australia.

Methods
Using deaths registered in Australia from 2006 to 2017 (n = 1773525) coded to the International Classification of Diseases (ICD) and an extended classification (n = 136 causes) based on a World Health Organization short list, we described MCoD data by cause. Age-standardised rates based on UC and MC were compared using the standardised ratio of multiple to underlying causes (SRMU) to estimate the contribution of the cause to mortality compared to using the UC approach. Comorbidity was explored using the cause of death association indicator (CDAI) to compare the observed joint frequency of a contributory-underlying cause combined with expected frequency of the contributory cause (with any UC).

Results
On average 3.4 conditions caused each death and 24.4% of deaths had 5 plus causes. Largest SRMUs were for genitourinary diseases (8.0), blood diseases (7.8) and musculoskeletal conditions (6.7). CDAIs showed high associations between, for example, accidental alcohol and opioid poisoning, septicaemia and skin infections, and traumatic brain injury and falls.

Conclusions
MC indicators enhance measures of mortality and reassess the role of causes of death for descriptive and analytical epidemiology.

Key messages
This research demonstrates the value of MC analysis for Australian mortality data.
856A gestational age specific prognostic model for adverse perinatal events in obese women
Authors: Bone Jeffrey , Lisonkova Sarka 
Published: September 2021

Abstract

Background
Obesity is one of the most preventable pre-pregnancy risk factors for adverse perinatal events. Despite this, there are few body-mass-index (BMI) specific prognostic models for timing of delivery associated with the lowest number of adverse perinatal events. Our aim was to build a predictive model to quantify gestational age-specific rates of adverse birth outcomes in obese women with and without additional risk factors.

Methods
All singleton births at ≥ 34 weeks’ gestation in British Columbia, Canada, 2008-2017 (n = 283,697) were included and data were obtained from the British Columbia Perinatal Database Registry. A multivariable Cox proportional hazards model including demographic and obstetric risk factors was used to estimate gestational age specific risk of composite perinatal mortality and severe morbidity.

Results
Among all women, 13.1% were obese (pre-pregnancy BMI ≥30m/kg2), 60.1% had normal BMI (18.5-24.9 m/kg2). In high-risk obese women (nulliparous with chronic hypertension, and diabetes), adjusted outcome rates (per 1000 ongoing pregnancies) were 7.5 at 34-36 weeks, 20.4 at 37-39 weeks, and 83.5 at ≥ 40 weeks’ gestation. In all obese women, the rates were 1.93, 6.27, and 18.5 per 1000 ongoing pregnancies, respectively. In contrast, on average these rates were 1.14, 4.03 and 11.6 per 1000 ongoing pregnancies, respectively, among women with normal BMI.

Conclusions
Obese women are at increased risk of poor perinatal outcomes at all gestational ages. These risks are compounded by other conditions known to effect perinatal outcomes.

Key messages
Obese women require specific guidelines for timing of optimal delivery.
205Zoonotic disease transmission risk in displaced populations
Authors: Braam Gates Scholar Dorien , Jephcott Freya , Wood James 
Published: September 2021

Abstract

Background
Repeated spillover events of zoonotic diseases from animals to humans, in combination with unprecedented levels of forced migration, present a major challenge to the global health security agenda. Infectious disease risk is affected by a range of ecological, political and socio-economic drivers.

Methods
This study uses a qualitative case study methodology to determine how displacement affects the risks of zoonotic disease transmission. Based on key informant interviews and observational studies in Jordan and Pakistan, the study analyses social-structural factors impacting zoonotic disease transmission.

Results
The study shows that displacement may influence zoonotic disease transmission through its impact on environmental, socio-economic and behavioural factors, influenced by historical, political and socio-economic processes. Sporadic outbreaks of zoonoses including cutaneous leishmaniasis, rabies and Tuberculosis are reported among displaced populations. Risk factors include a decline in health services, increased population density, changes in environment, and reduced quality and availability of shelter, water and nutrition, in turn determining vulnerability to vectors and pathogens.

Conclusions
Risk factors affecting zoonoses in displacement are complex and interlinked. While the presence of animals may increase the risk in densely populated areas lacking hygiene, livestock may be beneficial to the health status of displaced by improving nutrition. Responses need to be interdisciplinary, multilevel and contextualized.

Key messages
To mitigate the risk of zoonotic disease transmission during displacement, responses need to include pathogen and vector control, as well as reducing vulnerability to disease, including through access to health and veterinary services and humanitarian assistance.
1322A pilot study of faecal sample collection from prospective cohort study participants
Authors: Bruinsma Fiona , Giles Graham , Lynch Brigid , Whalen Theresa , Tsimiklis Helen , Southey Melissa , Milne Roger 
Published: September 2021

Abstract

Background
Faecal specimens offer a relatively accessible means of assessing the gut microbial community. We conducted a pilot study to compare the feasibility of different protocols for self-collection of faecal specimens from Australian Breakthrough Cancer (ABC) Study participants.

Methods
Pilot study participants were randomly selected from ABC Study participants who had not yet been invited to participate in follow-up. All pilot study participants were asked to provide a faecal sample using FOBT cards and complete a ‘day of sample’ questionnaire. Participants were randomised to 1 of 4 groups defined by combination of (i) a request (or not) to also provide a faecal sample using a tube containing 2.5ml of 95% ethanol and (ii) a request (or not) to complete a food frequency questionnaire.

Results
1,136 ABC Study participants were invited to participate in the pilot study. Of the 56% that opted in, 88% returned the requested sample. Very few participants (5%) actively opted out. Overall, 49% of invited participants returned a sample. There was no statistically significant difference between the groups in the percentage of participants who completed the pilot study.

Conclusions
The pilot study demonstrated the feasibility of self-collection of faecal samples. Increasing the time commitment and complexity (through provision of an additional sample suspended in ethanol and a FFQ) did not reduce the likelihood of successful completion.

Key messages
The findings demonstrate the feasibility of collecting faecal samples both on an FOBT card and in a tube containing ethanol, and a lengthy FFQ, within a prospective cohort study.
206Clinical Epidemiology Knowledge Retention in Accelerated Teaching and Learning
Authors: Carfagnini Quinten , Law Madelyn , Zahradnik Michelle 
Published: September 2021

Abstract

Background
Accelerated courses continue to be part of the changing landscape in medical education despite limited evidence to support their efficacy in relation to knowledge retention. The purpose of this study was to determine if a difference in knowledge retention exists over time between students enrolled in a traditional versus an accelerated clinical epidemiology course.

Methods
The current study incorporated an epidemiologic prospective cohort design. The course in clinical epidemiology focused on evidence-based decision making for diagnostic and therapeutic research methods and problem-based learning. Knowledge retention was assessed at four-times points (baseline, three, six and 12 months) for students enrolled in either traditional (13 weeks) or accelerated (1 week) courses. Linear mixed-effect regression modeling was incorporated to examine the change in trajectory of knowledge retention over four points in time between students enrolled in traditional and accelerated teaching formats.

Results
A significant main effect of traditional versus accelerated course format on retention of knowledge over time was not found (β=-0.341, p = 0.410), suggesting that knowledge retention is not compromised regardless of teaching format. Furthermore, the greatest diminished knowledge retention was observed between baseline and 12 months (β = 10.595, p &lt; 0.0001), followed by three months (β = 3.864, p &lt; 0.0001) and six months (β = 1.180, p &lt; 0.0001).

Conclusion
This study determined that accelerated course format does not compromise short- and long-term clinical epidemiology knowledge retention in students.

Key message
University administrators and faculty should not be suspicious of knowledge retention issues in accelerated courses and should endorse accelerated learning opportunities.
1023The uses and abuses of regression models: a new approach to teaching regression analysis
Authors: Carlin John , Moreno-Betancur Margarita 
Published: September 2021

Abstract

Focus of Presentation
Multivariable regression models are widely used in epidemiological data analysis. Traditional teaching often focusses on technical aspects with insufficient attention paid to the purposes for which regression methods are used.

Findings
We have addressed these issues in a new short course that provides an introduction to regression analysis in the context of learning about causal inference, beginning from the standpoint that the majority of research questions in epidemiology are causal in nature. This approach leads naturally to using regression models in two different ways, firstly for direct estimation of a causal effect, under an assumption of constancy of the effect across strata of confounders, and secondly for prediction of outcomes, as a necessary step in the estimation of causal effects via g-computation.

Conclusions/Implications
Approaching the teaching of regression methods within a causal inference framework helps to dispel confusion created by traditional statistical approaches that imply the existence of “true models” and encourage the building of models in a way that is unclear about the purpose for which they will be used, for example seeking to identify “risk factors” in an exploratory manner.

Key messages
The teaching and practice of regression methods in epidemiology can be enhanced by emphasising the key differences between three distinct analytic purposes: description, prediction, causal. Regression models may play a role in all three but the way in which models are developed and interpreted differs between them.
145Educational inequalities in primary prevention statin use in UK Biobank
Authors: Carter Alice , Gill Dipender , Morris Richard , Smith George Davey , Taylor Amy , Davies Neil , Howe Laura 
Published: September 2021

Abstract

Background
Socioeconomic inequalities in cardiovascular disease are well documented, but the association of socioeconomic position with treatment for cardiovascular disease prevention is unclear.

Methods
Using data from a large prospective cohort study, UK Biobank, we calculated QRISK3 cardiovascular risk scores for 472 097 eligible participants with complete data on self-reported educational attainment and statin use (55% female; mean age, 56).
We used logistic regression to explore the association between i) QRISK3 score and ii) educational attainment on self-report statin use. We then stratified the association between QRISK3 score, and statin use by educational attainment to test for interactions.

Results
For an equivalent QRISK3 score, more educated individuals were more likely to report taking statins. In women with 7 years of schooling, a one unit increase in QRISK3 score was associated with a 7% higher odds of statin use (odds ratio (OR) 1.07, 95% CI 1.07, 1.07). In women with 20 years of schooling, a one unit increase in QRISK3 score was associated with an 14% higher odds of statin use (OR 1.14, 95% CI 1.14, 1.15). Comparable ORs in men were 1.04 (95% CI 1.04, 1.05) for 7 years of schooling and 1.08 (95% CI 1.08, 1.08) for 20 years of schooling.

Conclusions
Individuals with less education are less likely to access statins conditional on cardiovascular risk factors.

Key messages
Inequalities in access to cardiovascular preventive medication are likely contributing to cardiovascular inequalities.
571Effect of a computer network-based feedback program on antibiotic prescription rates of primary care physicians
Authors: Chang Yue 
Published: September 2021

Abstract

Background
Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance.

Methods
A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians’ antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians.

Results
There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value = 0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value &lt; 0.001). After a further 3 months, the rate of decline in antibiotic prescriptions was also significantly greater in the intervention group compared to the control group (14.2% vs 4.6%, P-value &lt; 0.001).

Conclusions
A computer network-based feedback intervention can significantly reduce the antibiotic prescription rates of primary care outpatient physicians.

Key messages
The feedback intervention continuously affected their prescription behavior for up to six months.