bluuebunny/crossref_metadata_2025_split huggingface dataset:
702To determine socio-demographic corelates of reproductive tract infection amongst women of reproductive age group
Authors: Gupta Anmol 
Published: September 2021

Abstract

Background
Reproductive tract infection (RTI) is a public health problem, in developing countries like India. The associated odium with it is a stumbling block in seeking health care. So, our aim was to studyprevalence of RTI symptoms and its socio-demographic corelates.

Methods
A cross-sectional study was undertaken in the rural field practice area of Department of Community Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to June 2019. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymousinterview schedule was administered after taking consent.

Results
The prevalence of self-reported RTI’swas found to be 41.2%.It was more in lower socio-economic classes, and was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.

Conclusions
RTI infections were more prevalent among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health.

Key messages
The relevant and robust data on RTI’s, may be secured by capacity building of health workers. An exemplary drug supply system may be ensured, so that the RTI kits are available at government health institutions. An introduction of affordable point-of-care tests for sexually transmitted infection may be done, as recommended in the WHO Global Health Sector Strategy for the control and prevention of STIs.
519Innovative use of MedicineInsight GP database for applied research on antibiotic prescribing in Western Australia
Authors: Harrison Amy , Robinson Suzanne , Selvey Linda , Moorin Rachael , Harris Mark 
Published: September 2021

Abstract

Focus of Presentation
This project showcases the use of existing general practice (GP) datasets to gain access to large-scale data for epidemiological research. There is limited quantitative research on antibiotic prescribing in Australian GP. The research question involves identifying predictors of antibiotic prescribing not in accordance with national therapeutic guidelines for urinary tract infection (UTI) in Western Australian (WA) GP. This requires large-scale, individual-level data, which is difficult to access in Australia, and in this case could not be achieved without collaboration.

Findings
Longitudinal records from 52 practices in WA participating in MedicineInsight were analyzed. GP datasets present challenges regarding cleaning, processing and storage. Substantial broad-spectrum antibiotic prescribing was identified in initial episodes of UTI, particularly for children, and not supported by laboratory pathology. Children received broad-spectrum antibiotics 85% of the time, compared to 58% in women. Mixed-effects logistic regression was used to elucidate patient- and consultation-related factors associated with antibiotic prescribing outside of the guidelines.

Conclusions/Implications
There is evidence of antibiotic prescribing outside of the guidelines for initial presentations of UTI in WA GP. Whilst GP datasets provide insightful information on antibiotic prescribing, it is important to explore these findings with practising clinicians to further understand the drivers behind this behaviour, and this is the next stage of this research.

Key messages
Collaborative partnerships can facilitate access to rich, large-scale datasets capable of answering important research questions in Australian primary care.
709Inequalities and the role of sterilization in modern contraception in low- and middle-income countries
Authors: Hellwig Franciele , Barros Aluisio JD 
Published: September 2021

Abstract

Background
Contraceptive use has increased impressively in the last years. Our aim was to track the proportion of female sterilization in demand for family planning satisfied with modern methods (mDFPS) and its inequalities in terms of wealth.

Methods
Using data from national health surveys carried out since 2010 in 105 countries, we estimated mDFPS, separating according to type of method. Where the share of female sterilization was at least 25%, we analysed wealth inequalities in the share of sterilization by wealth quintiles and Slope Index of Inequality (SII).

Results
We included 20 countries, among which mDFPS varied widely (from 6% in Albania to 94% in Brazil). Female sterilization was reported by more than half of women in India, Dominican Republic, El Salvador, Mexico, and Colombia. Most countries presented higher use of sterilization among the richest, but inequality patterns varied greatly. Higher levels of pro-rich inequality were found for Guatemala and Costa Rica (SII of 0.24 and 0.22, respectively). Higher levels of pro-poor inequality were found for Albania and Brazil (SII of -0.25).

Conclusions
Despite the wider range of methods available, several countries present a large proportion of mDFPS satisfied through female sterilization.

Key messages
Sterilization might be recommended to some couples, however, its role in mDFPS is excessively high. Promotion of long-acting reversible contraceptives should be strengthened as they are easy to use, highly effective and do not eliminate women’s agency about maternity in the future.
915Inference on Causation from Examining Changes in Regression coefficients and Innovative STatistical AnaLyses (ICE CRISTAL)
Authors: Hopper John , Li Shuai , Bui Minh , Dowty James 
Published: September 2021

Abstract

Focus of Presentation
Causation is critical if epidemiology is to be relevant to public health. Mendelian Randomisation makes causal inference about from simply observing an association between the outcome and a genetic variable that has been conferred the title of “instrumental” because the proponents consider it satisfies some assumptions perfectly. We take this association as the starting point of a Popperian approach that tries to falsify causal hypotheses by relaxing assumptions and considering alternate models.

Findings
We developed methods to calculate test-of-fit statistics for different causal scenarios based on the joint changes in regression coefficients, using simulations and bootstrapping methods. Let Y be the outcome, X a putative cause, and G a potential instrumental variable associated with X and Y. We regress Y against X and G alone, and with X and G together. We predicted the changes to regression coefficients that should occur under three scenarios; (i) X causes Y, (ii) there is a factor C associated with Y, X and G. and (ii) Y causes X. We compared goodness-of-fit statistics across scenarios, and for combinations of scenarios (given multiple causal processes might co-exist). We present findings from application to data on body mass index and DNA methylation and compare with Mendelian Randomisation analyses.

Conclusions/Implications
Robust inference can be made but the sample sizes and strengths of associations need to be substantive.

Key messages
Causation is a fundamentally important issue that should, and can, be addressed by trying to disprove it, rather than by finding evidence for it.
888Discriminating between risk discriminators: OPERA, AUC, and polygenic variance
Authors: Hopper John , Dowty James 
Published: September 2021

Abstract

Focus of Presentation
Epidemiological risk estimates are often adjusted for age (and, if necessary, sex) by design or analysis, and for other factors. Consequently, risk estimates do not pertain to the crude risk factor, but to its population residual after adjusting for age, sex and other covariates. For disease risk, the change in Odds PER Adjusted standard deviation (OPERA) estimates the risk gradient on an appropriate scale; log(OPERA) is the natural measure to compare estimates.

Findings
Under a multiplicative risk model for a normally distributed (adjusted) risk factor, log(OPERA) = the difference in mean between cases and controls. The area under the receiver operating curve (AUC) = □(log(OPERA)/√2), where □ is the standard normal cumulative distribution function. The risk discrimination from combining risk factors can be predicted from their OPERAs. The polygenic standard deviation estimated from pedigree data = log(OPERA). The OPERA for knowing all familial risk factors can be calculated.

Conclusions/Implications
We present examples from the breast cancer literature where the wrong conclusions can be made by not using the OPERA concept. We give examples of the value of OPERA estimates in predicting the risk discrimination of their combination and demonstrate why the better one predicts the disease the harder it is to predict it better.

Key messages
OPERA overcomes problems about interpreting risk factors, and combinations of risk factors, in a way not apparent using changes in AUC. OPERA also puts an upper bound on the role of genetic factors in explaining differences in risk across the population.
890The prevalence and risk factors for Coxiella burnetii on commercial dairy goat farms in Australia
Authors: Hou Kangwei , Firestone Simon , Wiethoelter Anke , Stenos John , Lignereux Louis , Clark Nicolas , Aleri Joshua , Magalhães Ricardo , Stevenson Mark 
Published: September 2021

Abstract

Background
Despite the potentially important role that intensively managed dairy goats play in the spread of Q fever, the prevalence of Coxiella burnetii among dairy goat herds in Australia is largely unknown. The aim of this cross-sectional study was to estimate the prevalence of coxiellosis-positive dairy goat herds in Australia and to identify risk factors associated with coxiellosis positivity.

Methods
Owners or managers of commercial dairy goat herds were contacted and asked to complete a questionnaire about risk factors for coxiellosis and to provide a bulk tank milk (BTM) sample. BTM samples were tested using an enzyme-linked immunosorbent assay (ELISA) and real-time quantitative polymerase chain reaction (RT-PCR) targeting the Com1 and IS1111 sections of the C. burnetii genome. Questionnaire responses from coxiellosis positive and coxiellosis negative herds were compared using frequency cross-tabulations and multivariable logistic regression.

Results
Herd managers from 49 of the 61 commercial dairy goat herds in Australia took part in the study. Of this group, three BTM samples were found to be both ELISA and RT-PCR positive. Two BTM samples were ELISA positive but RT-PCR negative. There were 10 (95% CI 4.4 to 22) C. burnetii positive herds per 100 herds at risk.

Conclusions
The prevalence of coxiellosis among commercial dairy goat farms in Australia is relatively low.

Key messages
The Australian dairy goat industry should focus on biosecurity measures and risk management plans to reduce the probability of C. burnetii introduction.
128Study data within systematic reviews of intensive care interventions analysed as a cluster randomized trial
Authors: Hurley James 
Published: September 2021

Abstract

Focus of Presentation
Cluster randomized trials (CRT) can address infectious disease research questions at the whole-of-population level, such as herd protection and herd peril effects, that cannot be answered within randomized controlled trials. For adequate power, ideally, a CRT will have at least 40 clusters.

Findings
Studies of decontamination (using either chlorhexidine or topical antibiotics) to prevent ICU-acquired infections among adult patients requiring prolonged mechanical ventilation (MV) have been summarized in &gt; 15 systematic reviews. Of 83 studies of topical antibiotics, 69 had concurrent control (CC) versus non-concurrent control (NCC; n = 14) design (Figure below; solid symbols are intervention group patients). The mean ICU pneumonia incidence for topical antibiotic study CC control groups (34.5%; 95% CI, 29.1-40.4) is higher versus a literature benchmark (26.1%; 23.3%-29.1%), and versus NCC control groups (29.9%; 21.4-40.4) and versus chlorhexidine study CC control groups (25.5%; 19.6 – 32.5; n = 17).

Conclusions/Implications
Benchmarking the event rates among control groups versus the event rate among non-intervention studies for MV patients provide a measure of the contextual effect of the intervention. Differing intervention effects for studies with CC versus NCC design implicates herd effects.

Key messages
Systematic reviews of interventions that include studies with CC versus NCC design provide a natural experiment of contextual effects where their study otherwise would be difficult or, for adverse herd effects, unethical.
1414Hormone replacement therapy, oral contraceptives and stroke risk
Authors: Johansson Therese , Johansson Docent Åsa , Karlsson Torgny , Ek Docent Weronica E , Fowler Philip 
Published: September 2021

Abstract

Background
Millions of women use exogenous hormones as hormone replacement therapy (HRT) or oral contraceptives (OC). Still, time-dependent and long-term consequences of exogenous hormones on cerebrovascular health remains unclear.

Methods
We examined the effects of HRT and OC usage on stroke risk in 256,661 women from UK Biobank, born between 1939 and 1970. Outcomes included any type of stroke, ischemic stroke (IS), intracerebral hemorrhage (IH), and subarachnoid hemorrhage (SH). Exposures were analyzed as time-dependent variables in Cox regression models. Results are expressed as hazard ratios (HR) with 95% confidence intervals.

Results
During first year of exposure, HRT usage was associated with higher hazard rates of any stroke (HR = 2.12[1.66-2.70]), IS (HR = 1.93[1.04-3.56]) and SH (HR = 2.14[1.23-3.72]) compared to non-usage, which remained significant only for any stroke during remaining years of exposure. Similarly, we observed an increased hazard of any stroke during first year of OC exposure (HR = 2.29[1.34-3.92]), while the hazards were found to be comparable during remaining years of use (HR = 1.03[0.92-1.17]). Conversely, women who previously had been exposed to OC, had a lower hazard rate of any stroke later in life, (HR = 0.88[0.82-0.94]).

Conclusions
Our findings suggest that HRT and OC use cause immediate changes in hemostatic balance, therefore increasing the short-term stroke risk. However, long-term effects of OC use during reproductive years might improve cerebrovascular health and prevent stroke events later in life.

Key messages
HRT usage increase the risk of stroke, both short-term and with longer use, while the increased stroke risk might be limited to the first year of OC use.
896Quantifying cause-related mortality incorporating multiple causes: challenges and opportunities
Authors: Joshy Grace , Eynstone-Hinkins James , Moran Lauren , Balogun Saliu , Bishop Karen , Moreno-Betancur Margarita 
Published: September 2021

Abstract

Key contact person
Dr Grace Joshy, Fellow, Research School of Population Health, Australian National University.

Focus and outcomes for participants
Mortality statistics are typically based on a single underlying cause of death (UCoD), derived from multiple conditions on the death certificate, and have provided critical evidence for policy and practice for over a century. There have been radical shifts in patterns of death in the past couple of decades; deaths in older ages are increasingly from chronic and degenerative diseases. The relevance of assuming that a single disease is causing the death is diminishing, especially with an aging population structure and increasing life expectancy. This symposium will enable participants to understand the complexities associated with mortality reporting/coding, strengths and limitations of available statistical methods for using multiple causes of death (MCoD) and the importance of quantifying mortality incorporating MCoD.

Rationale for the symposium, including for its inclusion in the Congress
The use of a single UCoD rather than MCoD means that vast amounts of potentially useful data are largely ignored, which is likely to bias mortality estimates (including under- and over-reporting of the importance of certain causes of death). Despite global recognition of the urgent need to better integrate data on MCoD into mortality statistics, use of these data are challenging and limited. Complexities arise from the way mortality information is reported on death certificates and coded to form mortality collections; limited understanding of available statistical methods also adds to the complexity.
International Classification of Diseases 10th Revision (ICD-10) has been translated into 43 languages and it is being used by over 100 countries to report mortality data, a primary indicator of health status. The 2018 release of the 11th revision of the International Classification of Diseases, enriching data on multiple parameters including comorbidity, confers further urgency and a unique opportunity to optimise the use of MCoD in mortality reporting.
The World Congress of Epidemiology 2020 will provide a unique platform for wider discussions on the challenges and opportunities for using MCoD data. The symposium will provide a deeper understanding and enhanced the use of MCoD data. The speakers are engaged in cutting-edge NHMRC-funded research on mortality incorporating MCoD and development of novel statistical methods.

Presentation program
The symposium will feature presentations from six speakers.

Names of presenters
James Eynstone-Hinkins, Lauren Moran, Saliu Balogun, Karen Bishop, Margarita Moreno-Betancur, Grace Joshy
1385Hesitancy for Adult Vaccination -A New Paradigm for Research in India
Authors: Kalra Nikhita , Kalra Tanisha , Mishra Suruchi , Basu Saurav , Bhatnagar Nidhi 
Published: September 2021

Abstract

Background
Adult immunization has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out with the aim to assess hesitancy and factors influencing the uptake of vaccines in adults.

Methods
An online cross-sectional study was conducted among adults (age more than 20 years). Data collection was done by convenience sampling in January 2021. Information on awareness and perceptions regarding adult vaccination and immunization status of participants was collected. Data analysis was done using SPSS version 21.

Results
A total of 461 adults responded to the survey. Among those who had never received any vaccine in adulthood (n = 158), the reasons were lack of recommendation by healthcare providers (38.6%), lack of knowledge of vaccines (15.8%) and fear of adverse effects following vaccination (7.6%). Hesitancy for vaccines among those who were informed by healthcare workers was as follows: shingles (97.8%), human papillomavirus (92.1%), pneumococcal (91.1%), influenza (79.7%), varicella (79.4%) and tetanus (57.6%).

Conclusions
Reduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Hesitancy was highest for the shingles vaccine and least for the tetanus vaccine.

Key messages
Coverage of adult vaccination can be improved by formulating national guidelines and encouraging healthcare providers to raise awareness. In-depth qualitative studies are needed to understand the perception of adults towards vaccination.
1295School age outcomes in IVF-conceived children compared with controls: a population linkage study
Authors: Kennedy Amber , Vollenhoven Beverley , Hiscock Richard , Stern Catharyn , Walker Susan , Cheong Jeanie , Quach Jon , Hastie Roxanne , Wilkinson David , McBain John , Gurrin Lyle , MacLachlan Vivien , Agresta Franca , Baohm Susan , Tong Stephen , Lindquist Anthea 
Published: September 2021

Abstract

Background
There is interest in longer term outcomes in IVF-conceived offspring compared with those conceived naturally. So far, the findings have been conflicting. The Australian Early Developmental Consensus (AEDC) assesses children in their first year of primary school across five domains.

Methods
To compare school entry outcomes in IVF-conceived children with naturally conceived controls, we undertook a statewide data linkage study, with perinatal data (2005-2014) linked to data from IVF providers in Victoria and the AEDC. Our approach to analysis included: complete case analysis, multiple imputation of missing data, consideration of clustering (siblings) and inverse probability weighted modeling to adjust for covariates. Our primary outcome was an AEDC score indicative of developmental vulnerability in two or more domains. We adjusted for confounders: child’s age at assessment, sex, highest level of maternal education, maternal age, parity, SEIFA (Socio-Economic Indexes for Areas) quintile, language background other than English, and Aboriginal and Torres Strait Islander (ATSI) status.

Results
The linked dataset comprised 163,418 children, including 4,441 IVF-conceived children. The IVF-conceived population had older, more highly educated mothers who lived in more affluent areas and were less likely to be from non-English speaking backgrounds or identify as ATSI. IVF-conceived children were less likely to be developmentally vulnerable, in both unadjusted (RR 0.59, 95%CI:0.52-0.67, p &lt; 0.001) and adjusted analyses (aRR 0.72, 95%CI:0.58-0.88, p &lt; 0.001).

Conclusions
IVF-conceived were less likely to be developmentally vulnerable in their first year of schooling, compared with peers conceived naturally.
624Integrating human behaviour models with epidemiology to frame complex health problems
Authors: Khan Rabia 
Published: September 2021

Abstract

Focus of Presentation
Health problems are complex due to multiple interactions whose outcomes are not easily predicted with traditional epidemiology methods. The problems themselves require careful evaluation. Predictive models of human behaviour are potentially powerful tools to frame health problems, especially if the models can link the attributes and behaviour of individuals with the dynamics of the social and environmental systems within which they operate. We explore this potential by proposing a framework combining two modelling approaches — social network analysis (SNA) and agent-based modelling (ABM) - with epidemiological methods. We then apply this framework to understand why measles vaccination rates are decreasing across the world.

Findings
These techniques allowed us to understand the etiologic implications of heterogeneity within the population, social interaction, and environmental influences simultaneously, and to explore mechanistic interactions, feedback loops, and reciprocity between exposures and outcomes. This approach allowed us to frame complex social factors of health and disease in a holistic manner.

Conclusions/Implications
The proposed framework allows investigators to analyse complex health problems in a holistic manner. However, both SNA and ABM, and other modelling tools, are still too compartmentalised in application, despite the strong methodological and conceptual parallels between their uses in different disciplines.

Key messages
A fully integrated approach is needed to understanding complex health problems, which combines modelling approaches and the disciplinary insights of epidemiology and public health.