bluuebunny/crossref_metadata_2025_split huggingface dataset:
1153Marital dissolution in later life: Change in health behaviours and outcomes following divorce and widowhood
Authors: Ding Melody , Gale Jo-Anne , Bauman Adrian , Phongsavan Philayrath , Nguyen Binh 
Published: September 2021

Abstract

Background
Marital dissolution, such as divorce and widowhood, are common life events with potentially important implications on health. Previous research has found that those who have divorced or widowed tended to have a higher risk of mortality, however, the mechanisms for the observed associations are not well understood. We aimed to examine the association of divorce and widowhood with subsequent changes in health-related lifestyles, psychological outcomes, and overall health and wellbeing within both immediate and longer terms.

Methods
We used data from the 45 and Up study collected at baseline (T1, 2006-09), first (T2, 2010) and second follow-up (T3, 2012-16). Martial status and health-related outcomes were self-reported at all three time-points using validated questionnaires. Nine outcomes were examined, including lifestyles (smoking, drinking, diet and physical activity), psychological outcomes (distress, anxiety and depression) and overall health/well-being (self-rated health and quality of life). Logistic regression and generalised estimating equations were conducted adjusted for sociodemographic characteristics.

Results
Of the 33184 participants who were married/co-habiting at T1, after 3.4 years, 2.9% became divorced and 2.4% widowed. Those who divorced had much higher odds of smoking, having poor quality of life, high psychological distress, anxiety and depression at T2. Similar but weaker associations were observed for those who became widowed. After another 5 years of follow-up, however, the associations were much attenuated towards the null.

Conclusions
We found strong adverse short-term effects of marital dissolution on health outcomes, particularly within the psychological health domain. The effects, however, seemed to attenuate in the longer terms.
1179Intergenerational Effects of Violence on Women’s Perinatal Wellbeing and Infant Health Outcomes in Vietnam
Authors: Do Phuc Huyen , Baker Philip , Vo Van Thang , Tran Xuan Bach , Dunne Michael 
Published: September 2021

Abstract

Background
This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam.

Methods
A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and three months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems.

Results
One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = -1.3).

Conclusions
These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.

Key messages
Mothers with violent and adverse family backgrounds have twice the risk of poor mental health during pregnancy, and their infants have twice the risk of adverse birth outcomes. Social support during pregnancy may have a buffering effect by reducing the long-term impact of childhood traumatic events.
1282Causal inference in multi-cohort studies using the target trial approach
Authors: Downes Marnie , O’Connor Meredith , Olsson Craig A , Burgner David , Goldfeld Sharon , Spry Elisabeth A , Patton George , Moreno-Betancur Margarita 
Published: September 2021

Abstract

Focus of Presentation
Utilising data from multiple cohorts to address causal questions in health research has become increasingly widespread due to a number of advantages. These include improved precision of estimates, in particular to investigate effect heterogeneity as well as rare events and exposures, and the ability to examine the replicability of findings. However, undertaking causal inference in multi-cohort studies also faces several challenges, which makes clear causal thinking even more important than in single-cohort studies. We propose the use of the “target trial” framework for the conduct of causal inference in multi-cohort studies.

Findings
Using two case studies, the first considering the effect of maternal mental health on emotional reactivity and the second examining the influence of exposure to adversity on inflammatory outcomes in childhood, we describe and demonstrate how the target trial approach enables clear definition of the target estimand and systematic consideration of sources of bias. Considering the target trial as the reference point allows the identification of potential biases within each study, so that analysis can be planned to reduce them. Furthermore, the interpretation of findings is assisted by an understanding of the unavoidable biases that may be compounded when pooling data from multiple cohorts, or that may explain discrepant findings across cohorts.

Conclusions/Implications
Use of the target trial framework in multi-cohort studies helps strengthen causal inferences through improved analysis design and clarity in the interpretation of findings.

Key messages
The target trial framework, already well-established for casual inference in single-cohort studies, is recommended for the conduct of causal inference in multi-cohort studies.
220Longitudinal associations between social isolation and cognitive performance among middle-aged and older population in China
Authors: Duan Yanran , Ma Yilei , Yin Ping 
Published: September 2021

Abstract

Background
In China, more than 10% of the elderly suffer from cognitive impairment and there is more than 10 million elderly with Alzheimer's disease. We aim to examine the association between social isolation and cognitive function among the Chinese middle-aged and older population.

Methods
We used data from the China Health and Retirement Longitudinal Study (CHARLS). Cognitive performance and social isolation were assessed at baseline (2011) and follow-up (2013, 2015). We examined the trajectories of changes in cognitive performance and social isolation on the Latent Growth Model (LGM), and the independent effects of social isolation on the initial level and the subsequent development of cognition.

Results
After excluding respondents with missing key variables, we ultimately included 10,906 participants in the analysis. Cognitive performance and social isolation scores showed significant differences across time. After adjustment for the confounders, the coefficients of social isolation in the LGM indicated negative effects on cognitive performance in participants at three-time points (P &lt; 0.05). Controlling for the confounders, the path coefficient of the initial level of social isolation with the initial level and the slope of cognition was −1.53 and 0.22, respectively. Similarly, the slope of social isolation and the slope of cognition were significantly (negatively) correlated.

Conclusions
Results demonstrate that higher social isolation lowers the cognitive performance and the decrease in overall social isolation is significantly associated with an increase in cognition for the middle-aged and elderly persons.

Key messages
Cognition, Social isolation, Aging, Latent growth model
1273Confounding in the association between pregnancy complications and subsequent preterm birth
Authors: Dunne Jennifer , Tessema Gizachew Assefa , Pereira Gavin 
Published: September 2021

Abstract

Background
Underlying causal mechanisms that persist from pregnancy to pregnancy have potential to explain recurrence of pregnancy complications. We aimed to estimate the degree of confounding necessary to explain these associations.

Methods
This was a retrospective cohort study of women (n = 124,936) giving birth to their first and second singleton children in Western Australia 1998-2015, identified from the Midwives’ Notifications System. The investigated pregnancy complications were preterm birth (&lt;37 gestational weeks), pre-eclampsia, placental abruption, small-for-gestational-age and perinatal death. Adjusted relative risks (RR) and confidence intervals (CI) were reported. We simulated maternal obesity and derived E-values, a method to determine the magnitude of unmeasured confounding.

Results
Complications in first pregnancy were associated with higher risk of preterm birth in second pregnancy. RR’s were significantly higher when the complication was recurrent. For the association between pre-eclampsia at first term birth and subsequent preterm birth, the RR increased from 1.2 (95% CI 1.05-1.41) to 11.9 (95% CI 9.52-11.49) when the complication reoccurred. E-values were 1.73 and 23.22 respectfully. Relative risks did not change after adjustment for maternal obesity.

Conclusions
The strong associations between pregnancy complications and preterm birth support the assumption of shared underlying causes that persist from pregnancy to pregnancy. High E-values suggest that recurrent confounding is unlikely, as any such unmeasured confounder would have to be uncharacteristically large.

Key messages
Well-established single confounders cannot explain away the strong associations between complications in first pregnancy and a subsequent preterm birth.
742Analyzing the statistical pitfalls of treating mediators as confounders
Authors: Elmrayed Seham , Fenton Tanis , Metcalfe Amy , Brenner Darren 
Published: September 2021

Abstract

Background
Numerous studies indicated that infants born small-for-gestational-age (SGA) are at higher risk of overweight. However, the association between SGA and overweight may be due to overcontrolling for body size. This study aimed to analyze the effect of controlling for child’s weight and height in the association between SGA and overweight in children born preterm.

Methods
Data were obtained from the Preterm Infant Multicenter Growth Study (n = 1089). The association between SGA and overweight at 36 months corrected age (CA) was analyzed using logistic regression models: 1) crude, 2) adjusted for baseline covariates, 3) adjusted for baselines covariates with additional adjustments separately for child’s weight and height at 21 months CA. Marginal structural models (MSM) with stabilized inverse probability weights were used to estimate the direct effect of SGA on overweight.

Results
The crude and adjusted models yielded a null association (OR, 95% CI: 0.88, 0.26-2.96; 0.95, 0.28-3.29). Adjusting for later height reversed the effect (OR, 95% CI: 2.31, 0.52-10.26), and adjusting for later weight reversed the effect and provided a significant association (OR, 95% CI: 6.60, 1.10-37.14). The MSMs with height and weight considered as mediators indicated no direct effect of SGA on overweight (OR, 95% CI: 0.83, 0.14-5.01; 0.71, 0.18-2.81).

Conclusions
Overcontrolling for body size can falsely induce an association between SGA and overweight.

Key messages
Mediators should not be treated as confounders.
1086Methodological challenges using routine aggregated data in a primary care implementation trial on opioid prescribing
Authors: Farragher Tracey , Alderson Sarah , Carder Paul , Willis Tom , Foy Robbie 
Published: September 2021

Abstract

Focus of Presentation
There is international concern over rising trends in opioid prescribing, largely attributed to prescribing for chronic non-cancer pain. We conducted a controlled interrupted time series study on anonymised, aggregated practice data to evaluate the effect of the Campaign to Reduce Opioid Prescribing (CROP) in reducing the number of patients taking opioid medication in West Yorkshire UK practices targeted by the feedback intervention, compared to practices outside of West Yorkshire. We will discuss the methodological challenges addressed in the collection and analysis of these data, and the implications for using routine data in trials.

Findings
Primary care data sources for feedback interventions include large-scale databases (General Practice Research Database), high-level nationally gathered databases (OpenPrescribing.com) or data extracted directly from electronic health records (EHR). We will discuss the implications of the different sources of data and compare the results from each, in understanding the impact of the feedback intervention of reducing opioid prescribing over time. The consequences of the heterogeneity of the data sources on the interrupted time series analysis undertaken will also be discussed and solutions outlined.

Conclusions/Implications
Routine data are heterogeneous, with different purposes, structures and collection methods, which have considerable implications on their use, analysis and interpretation. Researchers need to understand that the utility of routine data sources have implications (both practically and methodologically) in conducting pragmatic trials, which should be considered when planning and conducting future studies using routine data.
1514Racial discrimination and anxiety symptoms in adolescents and young adults: a five-wave longitudinal analyses
Authors: Feijó Fernando , Feitosa Caroline , Salvi Leonardo , Gusmão Aline , Campos Felipe , Santana Vilma 
Published: September 2021

Abstract

Background
Racism is a major public health issue and may be associated with several mental health outcomes. However, more epidemiological analyses are necessary on the theme, particularly longitudinal studies. Therefore, we aimed to examine the association between perceived racial discrimination and anxiety symptoms during adolescence and young adulthood in a Brazilian metropolitan area.

Methods
A five-wave prospective longitudinal study started in 2000. Individuals were aged from 10 to 21 years at baseline, with clustered random sampling. Questions about the experience of racial discrimination were asked. PHQ-9 evaluated anxiety symptoms. Repeated measures analysis with GEE (Generalized Estimating Equations) estimated adjusted relative risks.

Results
There were 979 adolescents at baseline, with 19.9% (n = 195) reporting perceived racial discrimination and 26.5% (n = 259) with anxiety symptoms. A positive association was found between the perception of racism and anxiety symptoms, after adjustment for sex and age. When adding socioeconomic status, work and adverse environmental conditions, in the final adjusted model, the association was not substantially affected (RR = 1.52; 95% CI: 1.30-1.79).

Conclusions
The fight against racism and different types of discrimination and racial violence are urgent for public health. To assure high levels of ethical values and respect for fundamental human rights is still a challenge in the Brazilian society, still marked by the historical and shameful experience of slavery. Public policies, including health policies, in particular, must target the elimination racial discrimination as a central topic, reducing its consequences for mental health of black population.

Key messages
This study advances by adding a longitudinal analysis to a theme with a lack of epidemiological studies, especially longitudinal ones, contributing to the understanding of the association between racism in adolescence and mental health. The findings highlight the urgent need to fight racial discrimination as an ethical paradigm, reducing severe consequences of this type of violence on mental health.
195The Health4Life Initiative: An eHealth intervention targeting multiple lifestyle risk behaviours among Australian adolescents
Authors: Gardner Lauren , Champion Katrina , Teesson Maree , Newton Nicola , Kay-Lambkin Frances , Chapman Cath , Thornton Louise , Slade Tim , Mills Katherine , Sunderland Matthew , Allsop Steve , Hides Leanne , McBride Nyanda , Bauer Judith , Parmenter Belinda , Spring Bonnie , Lubans David 
Published: September 2021

Abstract

Background
Physical inactivity, poor diet, sedentary recreational screen time, poor sleep, alcohol use and smoking (the “Big 6”) are key lifestyle risk factors for chronic disease. The Big 6 typically emerge during adolescence, co-occur and continue into adulthood. To improve short- and long-term health, early and effective prevention is critical.

Methods
A cluster randomised controlled trial (ACTRN12619000431123) is being conducted in 71 schools across NSW, QLD and WA. Schools are randomised to the Health4life intervention or health education as usual. The intervention has three components: 1) An online, school-based program delivered to all Year 7 students; 2) An accompanying smartphone application (all students); 3) Booster content, delivered to at-risk students in Years 8 and 9. Students complete questionnaires on five occasions over three years.

Results
Preliminary analyses including 6716 students (49% female) indicated that 22% of participants met national guidelines for physical activity, 27% reported drinking 2+ cups of sugar-sweetened beverages/week, 3% had consumed a standard alcoholic drink in the prior 6 months, 2% had tried smoking, 86% engaged in excessive recreational screen time, and 32% had inadequate sleep. The final dataset will be analysed for the conference.

Conclusions
Many Australian adolescents are engaging in lifestyle behaviours that put them at risk of chronic disease. Effective and scalable preventive interventions that simultaneously target these behaviours are needed.

Key messages
This is the first trial of an eHealth intervention to concurrently target the Big 6 among adolescents. Health4Life has the potential to improve physical and mental health in adolescence and beyond.
245Comparison of methods for classifying heterogeneity in gestational diabetes (GDM) and association with outcomes
Authors: Gibbons Kristen , McIntyre David , Ma Ronald , Tam Wing Hung , Madsen Lene Ring , Sacks David , Catalano Pat 
Published: September 2021

Abstract

Background
Clinical experience suggests that diverse clinical subtypes exist within the broader diagnosis of GDM. Analysis from a single centre recently outlined heterogeneity in GDM with respect to insulin secretion and sensitivity, defining four GDM subtypes: 1) GDMsecr (&lt;25th centile HOMA-β (Hb) for non-GDM); 2) GDMsens (&lt;25th centile Matsuda Index for non-GDM); 3) GDMmixed (both GDMsecr and GDMsens); 4) GDMND, no defect (neither GDMsecr and GDMsens). Classification using these subtypes is associated with adverse outcomes.

Methods
Following similar methodology, women with GDM were classified into four subtypes including comparison of Hb, insulinogenic index (II) and Stumvoll first-phase estimate (SV) for defining GDMsecr. Analyses compared neonatal outcomes with non-GDM women and between GDM groups using c2 tests and regression analyses adjusted for multiple confounders including maternal age, BMI and HAPO study centre.

Results
Hb, II and SV gave divergent results for GDMsecr, with only 19% concordance. In all analyses, GDMND (10% by Hb, 6% by II, 6% by SV) showed outcome frequencies similar to those of non-GDM women; groups 1-3 showed higher risks (p &lt; 0.01 vs non GDM). These results persisted in the fully adjusted model (aOR generally &gt;2.0).

Conclusions
Different clinical subtypes in GDM are associated with differing risks of adverse outcome.

Key messages
Determination of GDM subtype can assist in assessing GDM women at higher risk of adverse clinical outcome and help guide clinical practice.
1399Associations of family wellbeing with face-to-face and instant messaging family communication amidst the COVID-19 pandemic
Authors: Gong Weijie , Sit Shirley Man Man , Lai Agnes Yuen Kwan , Wu Socrates Yongda , Wong Bonny Yee Man , Ho Sai Yin , Lam Tai Hing , Wang Man Ping 
Published: September 2021

Abstract

Background
Face-to-face communication has reduced amidst the COVID-19 pandemic. We examined the associations between family communication and family wellbeing.

Methods
In an online survey of the Hong Kong Jockey Club SMART Family-Link Project in May 2021, 4981 Hong Kong Chinese adults (mean age 43.5 years, response rate 24.3%) reported family communication methods of face-to-face and instant messaging (IM) when the COVID-19 pandemic was severe (yes/no), communication contents that were neutral, positive, supportive, and negative (yes/no), and communication quality (0-10). The associations of family wellbeing (health, happiness, and harmony, 0-10) with communication methods and contents were examined using linear regression (β), adjusting for each other, sex, age, socioeconomic status, and number of cohabitants. The mediating effects of communication quality on these associations were examined. Prevalence estimates were weighted by sex, age and education of general population.

Results
7.1% respondents reported no communication, 12.7% face-to-face only, 26.7% IM only, and 53.4% both. More communication contents were neutral (range 83.1-99.3%) than positive (42.1-62.2%), supportive (37.5-54.8%), and negative (10.9-34.5%). Communication quality was highest in using both methods (6.7 vs 4.5-6.6, all P≤0.02). Better family wellbeing was associated with using IM only (adjusted β: 0.37) and both methods (0.37) than face-to-face only and with positive (0.62) and supportive (0.45) contents (all P≤0.001). Communication quality mediated 35.2-93.5% of these associations.

Conclusions
Better family wellbeing was associated with IM and face-to-face communication and their contents, partly through communication quality.

Key messages
Family IM communication with positive and supportive contents may enhance family wellbeing amidst the COVID-19 pandemic.