bluuebunny/crossref_metadata_2025_split huggingface dataset:
337Systematic social observation tool for auditing the physical, built and social health-related urban neighboourhood environment
Authors: Middleton Nicos , Kleopa Daphne , Panayiotou Andrie , Kouta Christiana , Nicolaou Christiana , Kaifa Stalo 
Published: September 2021

Abstract

Background
Several generic or feature-specific neighborhood audit tools have been developed. While inter/intra-observer reliability if commonly assessed, validity is not always considered.

Methods
A two-phase mixed-methods process was used to develop the Cyprus Neighborhood Observational Tool for urban environments (CyNOTes). Phase I: draft based on literature review, culturally adapted and content validated in focus groups with community professionals and social media ethnographic study of citizens’ experience and feasibility tested across 15 neighbourhoods. Phase II: variability in features across 45 neighbourhoods along the social disadvantage continuum and associations with census area indicators, citizens’ perceptions and health-related quality of life were assessed.

Results
Content validity was supported by residents’ and professionals’ descriptions of neighbourhood problems, giving rise to a 17-domain, 151-item inventory, 126 from the literature and 25 arising via Nominal Group Technique consensus and content analysis of social media posts. With good inter- and intra-observer agreement, neighborhoods with lower educational attainment scored lower in over half domains. Social gradient and clustering of adverse features observed while in neighbourhoods with adverse features residents reported lower physical and mental health-related quality of life. The social gradient was not always reflected in the perception survey. With the exception of social aspects, residents did not rate the built and physical environment favorably. “Influence and sense of control” was rated lowest while “Citizens’ voice” emerged in the inductive content analysis of residents’ lived experience.

Conclusions
A culturally relevant audit tool of the health-related neighborhood microenvironment was developed by assessing its content, concurrent, criterion and predictive validity.

Key messages
There is need for valid audit tools, independent of residents’ perceptions, for supplementary profiling of the health-related neighbourhood microenvironment
Neighborhoods audits can trigger and widen conversation among local research community and policy-makers about health and place.
221Association of physical activity bout length and changing intensity with mortality in UK Biobank
Authors: Millard Louise , Tilling Kate , Gaunt Tom , Carslake David , Lawlor Deborah 
Published: September 2021

Abstract

Background
Spending more time active (and less time sedentary) is associated with many health benefits but it is unclear whether these associations differ depending on whether time spent sedentary or in moderate-vigorous physical activity (MVPA) is accumulated in long or short bouts. We used a novel analytical approach to examine whether length of sedentary and MVPA bouts associates with all-cause mortality.

Methods
We used data on 79,507 participants from UK Biobank. We derived the total time participants spent in activity categories (sleep, sedentary, light activity and MVPA) and in sedentary and MVPA bouts of short (1-15 minutes), medium (16-40 minutes) and long (41+ minutes) duration, on average per day. We used Cox proportion hazards regression to estimate the association of spending 10 minutes more average daily time in one activity or bout length category, coupled with spending 10 minutes less time in another, with all-cause mortality.

Results
Those spending more time in MVPA had lower mortality risk, irrespective of whether this replaced time spent sleeping, sedentary or in light activity. We found little evidence to suggest that mortality risk differed depending on the length of sedentary or MVPA bouts.

Conclusions
We uniquely show that higher total MVPA improves health irrespective of whether it is obtained from several short bouts or fewer longer bouts, supporting recent policy changes in some countries.

Key messages
Our results suggest that time spent in MVPA associates with lower mortality risk irrespective of whether it is obtained from several short bouts or fewer longer bouts.
149Interaction of socioeconomic status on the association between guardians’ sense of coherence and children’s caries
Authors: Mizuta Akiko , Aida Jun , Nakamura Mieko , Ojima Toshiyuki 
Published: September 2021

Abstract

Background
Untreated caries is the most prevalent disease in the world. A sense of coherence (SOC) contributes to oral health. However, little is known about the association between guardians' SOC and children’s oral health. We aimed to clarify the association between guardians’ SOC and their children’s caries based on socioeconomic status in Japan.

Methods
This study’s subjects were Japanese public junior high schoolers, aged 12-15, and their guardians. We administered a questionnaire survey among guardians in 2016 to assess their SOC and family environment. With their students’ consent, public junior high schools shared the results of the dental examinations. Multivariate logistic regression was conducted to clarify the association between guardians’ SOC and their children’s untreated decayed permanent teeth. We also conducted a stratified analysis according to a relative poverty line. Furthermore, we included interaction term of annual equivalent incomes, educational attainment with guardians’ SOC in analysis.

Results
We observed a significant inverse association between children’s untreated decay and their guardians’ SOC (OR 0.93). Equivalent annual income had a significant marginal association with decayed teeth (OR 0.14). The association of SOC was stronger in the low economic group (OR 0.64). In the high economic group, educational attainment was significantly associated with decayed teeth (OR 0.50).

Conclusions
Guardians with higher SOC were associated with children having fewer caries. Guardians’ SOC is a preventive factor for children’s caries, especially among children with low economic status.

Key messages
This result suggests that guardians’ SOC is one of the psychosocial determinant of children’s oral health.
1129Uncontrolled hypertension among patients with comorbidities; a systematic review and meta-analysis
Authors: Mohamed Shukri 
Published: September 2021

Abstract

Background
We did a systematic review and meta-analysis to estimate the prevalence of uncontrolled hypertension among patients with comorbidities in sub-Saharan African countries.

Methods
We searched MEDLINE via OVID, Embase, and Web of Science as well as Grey literature for studies published between January 2000 to June 15th, 2019 without setting or language restriction. Eleven comorbidities were considered for this review. Methodological quality of eligible studies was assessed, and random-effect models meta-analysis was conducted to estimate the pooled prevalence of uncontrolled hypertension among patients with comorbid conditions. Heterogeneity (I²) was assessed via the χ² test on Cochran’s Q statistic. This review is published in Systematic Reviews and registered in PROSPERO number CRD42019108218.

Results
We screened 7365 records of which 509 studies were included for full-text review. Following full text review, only 19 articles were included for meta-analyses. Ten articles were among diabetic patients, five articles among HIV patients, two were among stroke patents while chronic kidney disease and atrial fibrillation had one article each. The pooled prevalence of uncontrolled hypertension among patients with diabetes was 65·3% (95% prediction interval 69·5–96·1; I² 99·8%),

Conclusions
The prevalence of uncontrolled hypertension among patients with comorbidities is high in SSA.

Key messages
These findings strongly support an urgent need for comprehensive studies that report on the hypertensive treatment state and blood pressure control state of study participants with comorbidities.
314Data-adaptive methods for high-dimensional mediation analysis: Application to a randomised trial of tuberculosis vaccination
Authors: Moreno-Betancur Margarita , Messina Nicole L , Gardiner Kaya , Curtis Nigel , Vansteelandt Stijn 
Published: September 2021

Abstract

Focus of Presentation
Statistical methods for causal mediation analysis are useful for understanding the pathways by which a certain treatment or exposure impacts health outcomes. Existing methods necessitate modelling of the distribution of the mediators, which quickly becomes infeasible when mediators are high-dimensional (e.g., biomarkers). We propose novel data-adaptive methods for estimating the indirect effect of a randomised treatment that acts via a pathway represented by a high-dimensional set of measurements. This work was motivated by the Melbourne Infant Study: BCG for Allergy and Infection Reduction (MIS BAIR), a randomised controlled trial investigating the effect of neonatal tuberculosis vaccination on clinical allergy and infection outcomes, and its mechanisms of action.

Findings
The proposed methods are doubly robust, which allows us to achieve (uniformly) valid statistical inference, even when machine learning algorithms are used for the two required models. We illustrate these in the context of the MIS BAIR study, investigating the mediating role of immune pathways represented by a high-dimensional vector of cytokine responses under various stimulants. We confirm adequate performance of the proposed methods in an extensive simulation study.

Conclusions/Implications
The proposed methods provide a feasible and flexible analytic strategy for examining high-dimensional mediators in randomised controlled trials.

Key messages
Data-adaptive methods for mediation analysis are desirable in the context of high-dimensional mediators, such as biomarkers. We propose novel doubly robust methods, which enable valid statistical inference when using machine learning algorithms for estimation.
1383Interaction of cognitive decline and walking ability to influence wandering behavior: a cohort study
Authors: Murata Shunsuke , Takegami Misa , Ogata Soshiro , Ono Rei , Nakaoku Yuriko , Hagihara Akihito , Nishimura Kunihiro 
Published: September 2021

Abstract

Background
Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Though cognitive decline leads to wandering behavior, its effects may vary across walking ability. The purpose of this study was to investigate the joint effect of cognitive decline and walking ability on wandering behavior.

Methods
This retrospective cohort study in community analyzed 3920 elderly adults with dementia. The association of cognitive function and walking ability with an incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction was calculated.

Results
Compared to ‘walk independently’, adjusted risk ratios (95% confidence intervals) for ‘walk with help’ and ‘unable to walk’ were 0.51 (0.42, 0.63) and 0.21 (0.16, 0.28), respectively (P for trend &lt; 0.001). Compared to mild cognitive decline, adjusted risk ratios (95% confidence intervals) for moderate and severe cognitive decline were 1.44 (1.17, 1.77) and 1.73 (1.36, 2.18), respectively (P for trend &lt; 0.001). Additionally, some joint effects of cognitive decline and walking ability decline were lower than the sum of its individual effects (relative excess risk due to interaction (95% confidence interval), moderate cognitive decline × ‘walk with help’: -0.45 (-0.98, -0.01); severe cognitive decline × ‘unable to walk’: -0.95 (-1.71, -0.37)).

Conclusions
Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination.

Key messages
Our results help clinicians to predict and manage wandering behavior.
1134Seroprevalence and Risk Factors of Coxiella burnetti infection in the general population of Senegal
Authors: Djomo Patrick Nguipdop , Diop Sylvie Nyafouna , Dieye Ndeye Licka , Wotodjo Amélé-Nyedzie , Kim Min , Ba Elhadji , Guitian Javier , Mangtani Punam 
Published: September 2021

Abstract

Background
Coxiella burnetti, the causal agent of Q-fever, contributes to aetiologies of fevers of unknown origin (FUO) in West Africa. We compared its seroprevalence between Dakar, the largest urban centre in Senegal, and Niakhar, a rural area, and investigated the association to contacts with livestock and dairy products consumption.

Methods
Large cross-sectional surveys; households randomly selected using a two-stage cluster sampling. Within households, 1-2 participants were randomly selected using a Kish grid. A small blood sample was collected to detect phase 1 and 2 Coxiella burnetti IgG using ELISA, and a questionnaire was administered. Random effect logistic regression models were used to measure the association with risk factors.

Results
Overall, 2102 participants recruited in Dakar and 1156 in Niakhar. The prevalence of C. burnetti was high in both settings, but higher in rural Niakhar (37%) than urban Dakar (30%), even after adjusting for age, sex and socio-economic status (difference=7%; 95%CI [1.1% to 13%]; p = 0.02). In Dakar, ownership of sheep was associated with greater risk (OR = 1.26; 95%CI[1.00-1.59]; p = 0.048). Livestock contact was associated with higher risk in rural areas, but not in urban areas (helping cattle’s parturition (OR = 2.10; 95%CI [1.38-3.22]; p &lt; 0.01 and abortion (OR = 1.95; 95%CI[1.18-3.23]; p = 0.009). There was no association between dairy products’ consumption and Q-fever in both settings.

Conclusions
The high seroprevalence in urban and rural settings suggest that Q-fever should be seriously considered by clinicians when investigating fevers in both settings. The observed association with livestock contact is consistent with the lack of use of personal protection equipment.

Key messages
Clinicians should consider Q-fever among differential diagnosis when investigating non-specific fevers in West Africa.
383Pneumococcal conjugate vaccine is effective against hypoxic pneumonia in Laos, Mongolia and Papua New Guinea
Authors: Nguyen Cattram , Weaver Rupert , Blyth Christopher , Mollendorf Claire von , Britton Kate , Chan Jocelyn , Dance David A B , Ford Rebecca , Lai Jana Y R , Mungun Tuya , Newton Paul , Mulholland Edward Kim , Pomat William , Vilivong Keoudomphone , Xeuatvongsa Anonh , Russell Fiona M 
Published: September 2021

Abstract

Background
We describe a novel approach to determine PCV13 effectiveness (VE) against hypoxic pneumonia in children admitted with pneumonia in Lao People’s Democratic Republic (Laos), Mongolia and Papua New Guinea (PNG).

Methods
A 3-5 year prospective hospital-based observational study of children &lt; =59 months admitted with pneumonia was undertaken. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as an oxygen saturation &lt;90% in room air or requiring oxygen supplementation during hospitalisation. PCV13 status was determined by written record. VE was calculated using logistic regression comparing the odds of hypoxia between vaccinated and under-vaccinated pneumonia cases. To handle potential confounding, a propensity score (PS) analysis using inverse probability of treatment weighting (IPW) was used. In Laos, multiple imputation (MI) analysis was undertaken for missing data.

Results
The VE against hypoxic pneumonia were: in Laos, unadjusted 23% (95% CI: -9, 46%; p = 0·14), IPW adjusted 37% (6, 57%; p = 0.02), MI and IPW adjusted 35% (7, 55%; p = 0.02); in Mongolia, unadjusted 33% (26, 40%; p &lt; 0.001), IPW adjusted 33% (16, 47%; p &lt; 0.001); and in PNG, unadjusted 6% (-15, 24%; p = 0.53), IPW adjusted 36% (17, 51%; p = 0.001).

Conclusions
Our novel approach shows that PCV13 is effective against hypoxic pneumonia. PCV13 will contribute to reducing child mortality.

Key messages
We describe a novel, single hospital-based approach for determining VE that can be applied to other similar settings. This is one of the first studies showing PCV13 to be effective against hypoxic pneumonia in children in Asia.
1330Is Prognosis Worse for People with Multiple Versus Single Primary Melanoma?
Authors: Ni Yuan , Cust Anne E , Lo Serigne 
Published: September 2021

Abstract

Background
Patients with a primary melanoma may develop more than one in their lifetime. It is unclear whether mortality is worse after diagnosis of multiple primary melanoma (MPM) compared with single primary melanoma (SPM).

Methods
We analysed data from a population-based cohort of 3,869 patients diagnosed with primary in situ or invasive cutaneous melanoma in New South Wales, Australia in 2006-07 and followed up until 2018 (median 11.9 years) using linked mortality and cancer registry data. We compared overall mortality and melanoma-specific mortality for patients with SPM versus MPM, adjusting for other clinico-pathological prognostic indicators, using Cox proportional hazard models. The primary analysis was based on pathological features from the thickest tumour for MPM patients, however sensitivity analyses were performed using the first and last primary melanoma.

Results
The cohort consisted of 3,869 patients (2,929 SPM and 940 MPM) and 5,504 melanoma lesions (including 2,575 lesions from MPM patients). The primary multivariable analysis showed MPM was associated with lower mortality from all causes and melanoma compared with SPM with a hazard ratio of 0.62 (95% CI: 0.54-0.71, p &lt; 0.001) and 0.37 (95% CI: 0.32-0.43, p &lt; 0.001) respectively. These findings were also supported by the sensitivity analyses.

Conclusions
The diagnosis of MPM does not worsen mortality compared to a SPM, in fact it was associated with improved survival. This finding might be related to skin examination behaviours, biological or clinical factors.

Key messages
MPM patients have a better prognosis than SPM patients.
116Dementia risk in individuals with lifetime major trauma and post-traumatic stress disorder (PTSD) symptoms
Authors: Nilaweera Dinuli 
Published: September 2021

Abstract

Background
Increasing evidence suggests that stress may be a risk factor for dementia, however further investigation is required particularly in community-dwelling individuals. This study investigated whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with dementia risk.

Methods
Participants were 1,700 community-dwelling men and women enrolled in the ESPRIT study of later-life neuropsychiatric disorders. Lifetime major trauma and PTSD were assessed using Watson’s PTSD Inventory. Cognitive function was measured using tests of global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Fourteen-year incident dementia was diagnosed according to DSM-IV criteria. The association between lifetime trauma and cognition, as well as incident dementia was determined by multivariate logistic regression and Cox-proportional hazards regression, respectively.

Results
An unexpected, yet consistent finding was the association between lifetime major trauma without re-experiencing symptoms, and better baseline cognition (global OR: 0.67 [95% CI: 0.52-0.87], executive function OR: 0.69 [95% CI: 0.51-0.93]). Furthermore, lifetime trauma without re-experiencing symptoms was associated with a decreased risk of dementia (HR: 0.63, 95% CI: 0.44-0.91), particularly for females (HR: 0.49, 95% CI: 0.29-0.80).

Conclusions
Lifetime major trauma without re-experiencing symptoms may be protective for later-life cognitive function and could reduce dementia risk, especially in females. The mechanisms and moderating factors underlying these association requires further investigation.

Key messages
This study presents novel findings, and suggests that in some instances, experiencing traumatic events may be beneficial in later-life health.
460Social inequalities in second-hand smoking among Japanese adults: A repeated cross-sectional study
Authors: Noguchi Taiji , Kakizaki Masako , Wakabayashi Ryozo , Nakagawa Hiroko , Nishiyama Takeshi , Watanabe Miki , Hosono Akihiro , Shibata Kiyoshi , Ichikawa Mari , Kamishima Hiroyuki , Watanabe Hiroto , Ema Kanae , Nagaya Kenji , Yamada Tamaki , Suzuki Sadao 
Published: September 2021

Abstract

Background
We aimed to examine the association between educational history and second-hand smoke (SHS) exposure in Japanese adults.

Methods
We conducted a repeated cross-sectional study using data from the 2007-2011 baseline and the 2013-2016 follow-up survey in a Japanese suburban area. Overall, 5,562 male and 5,381 female non-smokers participated in the study, which evaluated the SHS exposure and educational history of the participants through self-reported questionnaires. We performed a multilevel ordered logistic regression analysis with survey year as the first level and the individual as the second level, SHS exposure as the dependent variable, educational history as the explanatory variable, and age, smoking history, marital status as covariates, stratified by gender and working status.

Results
The prevalence of SHS exposure was 45.4% in males and 41.9% in females in the 2007-2011 survey, and 31.6% in males and 28.7% in females in the 2013-2016 survey. Multilevel analysis indicated that less educational history was associated with higher SHS exposure in both genders (among males, the odds ratio compared with ≥13 years was 1.75 for 10-12 years and 1.64 for ≤9 years; among females, it was 1.79 for 10-12 years and 2.43 for ≤9 years). Stratified analysis by working status showed that for females, education-based inequalities in SHS exposure more strongly impacted for workers than non-workers (p for interaction &lt;0.001).

Conclusions
Education-based inequalities in SHS exposure exist in Japan and might be severe among female workers.

Key messages
Measures against SHS in Japan should be promoted to reduce social and gender inequalities.
484Reduced glomerular filtration rate and risk of stroke
Authors: Oh Doctor Chang-mo , Ryoo Jae-Hong 
Published: September 2021

Abstract

Background
Although chronic kidney disease is recognized as an independent risk factor for cerebrovascular disease, its association with hemorrhagic and ischemic stroke remains controversial.

Methods
A retrospective cohort study conducted using the National Health Insurance Service-National Sample Cohort, which is representative of the entire Korean population. Overall, 196,005 Korean who were not diagnosed with ischemic and hemorrhagic stroke before 2009 were included from 2009 to 2013. The eGFR was divided into six categories (≥90, 75–89, 60–74, 45–59, 30–44, &lt;30 mL/min/1.73 m2). The Kaplan-Meier plot was illustrated to compare the cumulative incidence of ischemic stroke and hemorrhagic stroke. Cox proportional hazard model was used to estimate the hazard ratio (HR) of eGFR for risk of ischemic and hemorrhagic stroke.

Results
During an average of 4.36 years follow-up period, 2,236 and 668 people were diagnosed with newly ischemic stroke and hemorrhagic stroke, respectively. Among people with eGFR&gt;90 mL/min/1.73 m2, age and sex adjusted incidence rate for ischemic stroke was 452.3 per 100,000 person-years, whereas the adjusted incidence rate for ischemic stroke among people eGFR with 30-44 and 45 mL/min/1.73m2 was 833.5 and 617.7 per 100,000 person-years, respectively. After adjusting for multiple covariates, the adjusted HR for ischemic stroke increased with decreasing eGFR (p for trend=0.005). However, there was no significant dose-response relationship between eGFR and risk of hemorrhagic stroke.

Conclusions
Reduced glomerular filtration rate less than 45 mL/min/1.73 m2 was associated with an increased risk of ischemic stroke but not hemorrhagic stroke.

Key messages
Reduction in kidney function had inverse dose-response relationship with the risk of ischemic stroke, but not with the hemorrhagic stroke. Especially, the risk of ischemic stroke was markedly increased from estimated glomerular filtration rate &lt; 45 mL/min/1.73 m2.