bluuebunny/crossref_metadata_2025_split huggingface dataset:
1260Contribution of risk factors to disease burden in Australia in 2018
Authors: Gourley Michelle ,   Australian Burden of Disease Study team
Published: September 2021

Abstract

Background
The Australian Burden of Disease Study 2018 estimated the burden due to 219 diseases and injuries and 40 risk factors (attributable burden). Attributable burden is the amount of health loss that would be prevented if exposure to the risk factor had been avoided or reduced to the lowest possible exposure.

Methods
Attributable burden was estimated for 2003, 2011, 2015 and 2018 using comparative risk assessment methodology. Estimates of exposure to risk factors were sourced from Australian survey data and used with global measures of effect size to estimate population attributable fractions (PAFs).

Results
In 2018, 37% of the burden of disease in Australia could have been prevented by reducing or avoiding exposure to the modifiable risk factors included in the study. The leading five risk factors contributing to total burden were: tobacco use (8.6%), overweight & obesity (8.4%), dietary risks (5.4%), high blood pressure (5.1%) and alcohol use (4.5%). While tobacco use remains the leading risk factor causing burden, the gap between tobacco use and overweight & obesity has almost closed. The burden attributable to most risk factors was higher in males than in females. The lowest socioeconomic group experienced greater burden compared with the highest group for all risk factors.

Conclusions
Addressing modifiable risk factors could prevent up to 37% of disease burden in Australia.

Key messages
In 2018, 37% of the burden of disease could have been prevented. Tobacco use and overweight & obesity were the leading risk factors.
1469Inequalities in diabetes management by area deprivation: the mediating role of healthcare resource distribution
Authors: Ha Rangkyoung , Jung-Choi Kyunghee 
Published: September 2021

Abstract

Background
We sought to identify the existence of regional socioeconomic inequalities in diabetes management and to examine whether the distribution of healthcare resources could explain regional inequalities in diabetes management.

Methods
Data were derived from the Korean Community Health Survey in 2018. Our study subjects included 23,760 participants who have been diagnosed with diabetes by a doctor. The dependent variables were self-reported glycemic control, Hemoglobin A1c (HbA1c) testing, recognition of the term HbA1c, and diabetic complications testing. Socio-demographics, health behavior-related factors, and factors related to regional healthcare resources were considered as potential mediating variables in explaining the association between diabetes management and area deprivation. A multilevel logistic regression analysis was used.

Results
Compared to the least deprived area, the likelihood of not taking HbA1c tests, not recognizing the term HbA1c, and not taking diabetic complication tests in the most deprived area were approximately 1.5, 2.6, and 2 times higher, respectively. In the most deprived areas, the coefficient of variation value of clinics was the highest and the number of doctors was the lowest. Regional healthcare resource factors explained regional inequalities in managing diabetes by 14% to 18%, especially in the most deprived area.

Conclusions
Policy interventions for more even distribution of healthcare resources would contribute to reducing the magnitude of regional inequalities in diabetes management.

Key messages
Our study suggests that reducing inequality in diabetes management could be possible through the appropriate allocation of healthcare resources.
315A new strategy for teaching Epidemiology in Public Health Education: Hybrid Team Based Learning-Personalised Education
Authors: Ha Tam , Kemp Byron , Wallace Margaret 
Published: September 2021

Abstract

Focus of Presentation
Hybrid Team Based Learning and Personalised Education (HTBL-PE) is an unique student-centred teaching strategy used to teach epidemiology in the Bachelors of Public Health at the University of Wollongong. It aims to systematically build abilities in epidemiology; strengthen self-confidence and belief, by teaching the way students learn and harnessing team’s capabilities to strengthen the individual.

Findings
73 out of 84 students enrolled in Spring 2019, completed surveys at the beginning and end of semester (87%). At the end of semester, the vast majority of students indicated their interest in epidemiology increased (93%), critical thinking had improved (92%), and their confidence as independent learners had increased (86%). More than two thirds of the students had already applied learnings from this subject in other settings (67%). In general, these outcomes did not differ significantly by gender or across learning styles. Students’ final mark for this subject was significantly higher than their Weighted Average Mark (WAM) prior to the semester (+17.4, p &lt; 0.001). Mean scores were &gt;84/100 overall for the subject (&lt;0.5% failure rate).

Conclusions
HTBL-PE is a new, innovative teaching strategy with low failure rates and high mean scores. Successful attainment of learning outcomes did not differ across gender or learnings styles.

Key messages
HTBL-PE is an effective teaching strategy with positive student outcomes. It caters to a variety of students and learning styles with evidence students have applied these techniques to other learning settings.
440Women and children’s experiences of international male migration for labour in Nepal
Authors: Stevens Kaila , Heyworth Jane , Dantas Jaya , Reid Alison , Saunders Julie 
Published: September 2021

Abstract

Background
At least 10% of the Nepalese population is estimated to be working abroad. Typically, those abroad are young men with families from agricultural backgrounds. Research regarding the impact on the family left behind in Nepal is growing but has focused on singular issues rather than the multifaceted effects of migration. This study aimed to gain an in-depth understanding of the challenges and benefits of migration for wives and children left behind.

Methods
Thirty-two qualitative semi-structured interviews were undertaken in Kathmandu and Kaski districts of Nepal. Eligible participants were women who had a husband who had migrated abroad for work and a child under the age of five. Interviews were conducted in Nepali, translated and transcribed to English, then coded and analysed using inductive Thematic Analysis.

Results
Three overarching themes were developed: Migration as a livelihood strategy, Migration as a trade-off, and Adaptation to the situation. The financial benefits of migration included improvements in children’s education and access to food and housing. Challenges identified were women’s increased labour burden inside and outside the home, psychosocial stress, and changed child-father relationships. Change in women’s empowerment was dependent on socio-demographic factors.

Conclusions
Migration often resulted in the improvement of economic circumstances. However, challenges being faced by women and children largely shifted from financial to emotional.

Key messages
The effects of migration are mediated by contextual factors. Given the ongoing reliance on migration for work, strategies should be employed to optimise the benefits and mitigate the consequences of those who remain.
651The voice of Indian women on family planning: A qualitative systematic review and meta-synthesis
Authors: Hoogar Praveen , Pujar Ashwini , Dhyani Vijay Shree , Parsekar Shradha S. 
Published: September 2021

Abstract

Background
This systematic review and meta-synthesis was conducted to explore the views and experiences of women on family planning in India.

Methods
We included qualitative studies conducted in India and published in English. PubMed, SCOPUS, Web of Science, CINHAL and ProQuest were searched from inception till April 2019. Population of interest were women in reproductive age group. Additionally, husband of the woman and mother-in-law were eligible to be included. Studies conducted among HIV positive, commercial sex workers and drug addicts were excluded. Selection of studies (titles, abstracts and full tests screening), data extraction and methodological quality assessment (using CASP checklist) was undertaken independently by four authors in pairs. Any discrepancies were resolved by discussion until consensus. Thematic analysis was used to analyse the data (PROSPERO registration number CRD42018093960).

Results
We included 39 full texts through database and reference searching. Most of the women were married. Main themes were; ‘family influence’, ‘perceived benefits/harm of son/daughter’, ‘perceived misconception of contraception’, ‘socio-cultural norms’, ‘abortion as a family planning option’, ‘healthcare reach and mistrust’ and ‘demographic dividend’.

Conclusion
There is a need to include husband and mother-in-law while delivering messages or strategies to women on family planning in India. Traditional norms are deep rooted in the community therefore, family planning strategies should be context and need based.

Key message
Meta-synthesis is a promising approach to gather evidence of complex health problems that require an understanding of social and cultural determinants of health.
399The causal effect of BMI on neurodevelopment: a within family Mendelian randomization study using MoBa
Authors: Hughes Amanda , Morris Tim , Ayorech Ziada , Tesli Martin , Ask Helga , Askeland Ragna , Reichborn-Kjennerud Ted , Johansson Stefan , Andreassen Ole , Magnus Per , Helgeland Øyvind , Njølstad Pål , Smith George Davey , Davies Neil , Howe Laura , Havdahl Alexandra 
Published: September 2021

Abstract

Background
Higher BMI in childhood predicts subsequent neurodevelopmental and emotional problems, but it is unclear if associations are causal. Observational studies are vulnerable to reverse causation and confounding. Mendelian randomization (MR) studies with unrelated individuals can also suffer from familial biases, such as dynastic effects (“genetic nurture”).

Methods
We apply within-family MR (WFMR) to overcome these biases. We used genetic information from 26,370 family trios in the Norwegian Mother, Father and Child Cohort Study (MoBa) to construct BMI polygenic scores in children and both parents. By using all three polygenic scores to instrument BMI, we avoided familial biases affecting previous studies.

Results
Multivariable-adjusted and conventional MR models implied an impact of children’s BMI on depressive, ADHD, and autism symptoms. In conventional MR models, a 5kg/m2 increase in BMI corresponded to depressive symptoms 0.49 SD higher (95%CI: 0.24-0.73), and ADHD symptoms 0.49 SD higher (95%CI: 0.28-0.70). WFMR estimates were less precise but gave little evidence of causal impacts of children’s BMI. Maternal BMI was positively associated with children’s depressive (0.16 SD per 5kg/m2, 95%CI: 0.04-0.28) and autism symptoms, and paternal BMI with children’s ADHD symptoms.

Conclusions
Compared to conventional MR models, MR models accounting for parental genotype found less evidence of causal effects of children’s own BMI on emotional and neurodevelopmental symptoms. The discrepancy may suggest an influence of family or population-level effects.

Key messages
The influence of children’s own BMI on emotional and neurodevelopmental problems may have been overstated. Parental BMI, familial or population level effects may influence these outcomes.
924The landscape of clinical trial activity focusing on Indigenous health in Australia from 2008-2018
Authors: Hunter Kylie , Xu Gemma , Modi Danai , Askie Lisa , Jamieson Lisa , Brown Alex , Seidler Anna Lene 
Published: September 2021

Abstract

Background
There are major health disparities between Indigenous and non-Indigenous Australians. To address this, it is vital to understand the landscape of Indigenous trial activity.

Methods
We extracted data from all Australian trials registered between 2008-2018 on the Australian New Zealand Clinical Trials Registry or ClinicalTrials.gov. Indigenous-focused trials were identified by searching for relevant terms such as ‘Indigenous’ and ‘Aboriginal’. Indigenous versus non-Indigenous trials and Australian trials overall were compared by conditions studied, intervention type, study design and funding.

Results
Of the 9206 included trials, 139 (1.5%) focused on Indigenous health, and these were mostly in ‘Public Health’ (n = 69, 50%), ‘Mental Health’ (n = 35, 25%) and ‘Cardiovascular’ (n = 25, 18%) (Figure). Compared to other Australian trials, Indigenous trials more frequently studied ear conditions (OR 16.47, 95%CI=8.43-29.99) and public health (OR 4.87, 95%CI=3.65-6.41), and were more likely to focus on screening (OR 3.57, 95%CI=2.10-5.70) and prevention (OR 2.24, 95%CI=1.61-3.08) rather than treatment (OR 0.40, 95%CI =0.30-0.52). They were less likely to be blinded (OR 1.72, 95%CI=1.20-2.49), or have any industry involvement (OR 2.52, 95%CI=1.54-4.43).

Conclusions
Indigenous trials differed from other Australian trials in health conditions studied, intervention focus, blinding and industry involvement. Relative to population size and burden of disease, the number of trials focusing on Indigenous health is low.

Key messages
Trial registries can be used to explore whether research appropriately addresses diverse populations such as Indigenous Australians. This can inform future research prioritisation.
695Gene and environmental factors for liver fibrosis among Japanese general population with NAFLD
Authors: Ibusuki Rie ,   Ippei Shimoshikiryo,   Daisaku Nshimoto,   Hironori Miyahara,   Koichi Tokushige,   Toshiro Takezaki
Published: September 2021

Abstract

Background
A part of nonalcoholic fatty liver disease (NAFLD) develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Metabolic syndrome is involved in their development, and hepatic fibrosis plays an important role in their pathogenesis. Patatin-like phospholipase domain-containing protein 3 (PNPLA3) gene encode proteins on hepatic lipid metabolism regulation, and PNPLA3 gene polymorphism is associated with the development and progression of NAFLD. To investigate the gene and environmental factors, and their interaction for liver fibrosis, we conducted a prospective study among Japanese general population with NAFLD.

Methods
The subjects were 295 general residents who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed for 5 years. NAFLD was defined as fatty liver using abdominal ultrasonography. PNPLA3 C/G polymorphism (rs738409) was analysed using TaqMan PCR. Hepatic fibrosis was defined using FIB 4 index (≥1.3). Logistic regression model was used to estimate the odds ratios (ORs) after adjusted for confounding factors.

Results
Mean age was 55.1 years and liver fibrosis was observed at 73.2% among NAFLD subjects. No environmental factors were associated with liver fibrosis, and PNPLA3 GG genotype was not associated with liver fibrosis, too. However, the ORs of CC & CG, and GG genotypes for dyslipidemia was respectively 0.45 (0.19-1.04) and 11.9 (1.81-78.4), and their interaction was significant (p = 0.01).

Conclusions
The interaction between PNPLA3 GG gene polymorphism and dyslipidemia for liver fibrosis was observed.

Key messages
Genetic susceptibility with dyslipidemia may be involved in liver fibrosis of NAFLD.
783Lifetime alcohol intake and stomach cancer risk: a pooled analysis of two prospective cohort studies
Authors: Jayasekara Harindra , MacInnis Robert , Yang Yi , Hodge Allison , Mitchell Hazel , Haydon Andrew , Room Robin , Hopper John , Gunter Marc , Riboli Elio , Giles Graham , Milne Roger , English Dallas , Ferrari Pietro 
Published: September 2021

Abstract

Background
Alcohol consumption is causally linked to several cancer sites but the evidence for stomach cancer is still inconclusive. We aimed to quantify the association between alcohol intake and risk of stomach cancer, including subtypes.

Methods
We pooled data from two cohort studies including 452,958 individuals enrolled in the European Prospective Investigation into Cancer in 1992-98 and 38,756 Australians enrolled in the Melbourne Collaborative Cohort Study in 1990-94. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident stomach cancer were estimated using Cox regression.

Results
1,225 incident stomach cancers were diagnosed over 7,094,637 person-years. Alcohol intake was not associated with overall stomach cancer risk. We observed a weak positive dose-response association for lifetime intake with non-cardia stomach cancer (HR = 1.03, 95% CI: 1.00-1.06/per 10 g/day increment), which is the more common type (77.6% of cases), and a weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) (phomogeneity=0.006). These associations did not differ appreciably by smoking or Helicobacter pylori infection status. Differences in HRs between diffuse-type and intestinal-type cancer were minimal (phomogeneity=0.97). HRs of 1.50 (95% CI: 1.12-2.01) for non-cardia and 0.53 (95% CI: 0.27-1.02) for cardia cancer were observed for a life course trajectory characterised by sustained heavy drinking compared with light drinking (phomogeneity=0.01).

Conclusions
Lifetime alcohol intake was associated with increased risk of non-cardia stomach cancer. The inverse association for cardia cancer indicates aetiologic differences between subsites.

Key messages
Limiting long-term alcohol consumption, and avoiding heavy use in particular, might be beneficial in preventing non-cardia stomach cancer.
473Preventable pertussis burden in Australia within the first year of life by improving vaccination timeliness
Authors: Jayasundara Duleepa , Randall Deborah , Sheridan Sarah , Sheppeard Vicky , Liu Bette , Richmond Peter , Blyth Christopher , Wood James G , Moore Hanna C , McIntyre Peter B , Gidding Heather F 
Published: September 2021

Abstract

Background
Previous Australian studies have shown that on-time Diphtheria-Tetanus-Pertussis (DTP) vaccination coverage is 50-60% in certain subpopulations. We estimated the potentially preventable burden of pertussis if, 1) the full primary course and, 2) each dose was given on-time.

Methods
Perinatal, immunisation, pertussis notification, and death data were linked for 1,412,984 infants born in two Australian states in 2000-2012. A DTP dose administered &gt;15 days after the recommended age was categorised as delayed. For aim 1, pertussis rates up to 1-year of age were compared in infants with ≥1 dose delayed versus all doses on-time, using Poisson regression methods. For aim 2, the expected number of cases preventable by each dose was calculated as the product of the number of cases observed during the period of delay and (1 – dose-specific vaccine effectiveness).

Results
58% of infants had all primary DTP doses on time. We estimated that 85 (95% CI: 61-109) cases per 100,000 infants, aged 39-days to 1-year, could have been prevented if all infants had been vaccinated on time; 77% of these infants had received ≥1 DTP dose within the first year of life. Estimated preventable burden attributable to delayed DTP1 (58/100,000) was higher than for DTP2 (26/100,000) and DTP3 (15/100,000).

Conclusions and Key messages
Poor vaccine timeliness, especially delayed DTP1, is a key contributor to the residual burden of pertussis. These findings can inform cost-benefit analyses of targeted programs and public health messaging to reduce delays.
807Association between diabetes and adjuvant chemotherapy implementation among patients with stage III colorectal cancer
Authors: Kanehara Rieko , Goto Atsushi , Watanabe Tomone , Inoue Kosuke , Taguri Masataka , Kobayashi Satoshi , Imai Kenjiro , Saito Eiko , Katanoda Kota , Iwasaki Motoki , Ohashi Ken , Noda Mitsuhiko , Higashi Takahiro 
Published: September 2021

Abstract

Background
Preexisting diabetes may contribute to the indication for adjuvant chemotherapy among patients with colorectal cancer (CRC); however, the association between diabetes and its implementation is largely unknown.

Methods
We analyzed the hospital-based cancer registry and health claims data of patients with stage III CRC who received curative surgery in 2013 in Japan (n = 6,344). Chemotherapy and diabetes was identified based on procedure, prescription, and diabetes codes in claims data. We examined the association between diabetes and implementation rate of adjuvant chemotherapy using the generalized linear model adjusted for age, sex, and updated Charlson Comorbidity Index, hospital type, and prefecture. We further applied a mediation analysis to examine the extent to which postoperative complications mediated the association.

Results
Of these, 1,236 (19.5%) had diabetes. Compared with those without diabetes, patients with diabetes were less likely to receive adjuvant chemotherapy (crude rate: 58.9% and 49.8%; adjusted percentage point difference: 4.7% [95% confidence limits: 1.7, 7.5]). Mediation analysis indicated that postoperative complications explained 9.4% of the association between diabetes and adjuvant chemotherapy implementation.

Conclusions
Our findings suggest that patients with stage III CRC and diabetes are less likely to receive adjuvant chemotherapy than those without diabetes, and postoperative complications may partially account for the association.

Key messages
Concomitant diabetes might negatively impact the implementation rate of adjuvant chemotherapy in patients with stage III CRC.
1496Spatiotemporal patterns of Kawasaki disease in South Korea: using 2008-2017 national representative data
Authors: Kim Jeehyun , Hong Kwan , Yum Sujin , Gómez Raquel Elizabeth Gómez , Chun Byung Chul 
Published: September 2021

Abstract

Background
Despite the etiology of Kawasaki Disease (KD) remains unknown, identifying spatiotemporal clusters of KD could support its hypothesis to be infectious disease. However, spatiotemporal clusters of KD have never been reported in South Korea. Therefore, this study aims to analyse the spatiotemporal patterns of KD in South Korea using national representative data.

Methods
We extracted epidemiologic-week (Epi-week) based KD case (ICD-10-CM code, M303) from 2008-2017 national health insurance service data in municipal level. To determine whether spatial autocorrelation and municipal-level clusters exist, year, sex, and age group (&lt;5, 5-9) stratified Global Moran’s I statistics and LISA spatial scan statistics on KD incidence were conducted.

Results
A total of 98,503 cases of KD were reported in 2008-2017 (aged &lt;5: 72,562 cases [73.7%]). Mean diagnosis age was 4.2±7.0 years, and male-to-female ratio was 1.39:1. Incidence among patients aged &lt;5 increased since 2008; the highest in 2016 (396.78 per 100,000 population). KD had seasonality of winter and summer. Epi-week 46-52 was the most frequent season for cases aged &lt;5, while Epi-week 1-5 was the most frequent season for cases aged 5-9. Positive spatial autocorrelation was consistently reported in every stratum except for ‘2012year/female/age5-9’ and ‘2015year/female/age5-9’ stratum. High-high clusters were consistently detected in the eastern part of South Korea in every stratum.

Conclusions
South Korea had steady increase in KD incidence since 2008 and municipal-level clusters throughout 2008-2017.

Key messages
Kawasaki disease in South Korea had spatiotemporal patterns.