bluuebunny/crossref_metadata_2025_split huggingface dataset:
557Outcomes of Indigenous multifetal and singleton pregnancies: complications, medical care, birth experience and infant health
Authors: Gibberd Alison , Tyler Jessica , Preen David , Falster Kathleen , Hanly Mark , Clarke Marilyn , McNamara Bridgette , Eades Sandra 
Published: September 2021

Abstract

Background
Perinatal outcomes for singleton pregnancies are poorer, on average, for Aboriginal people than non-Aboriginal people, but little is known about Aboriginal multifetal pregnancies. Yet multifetal pregnancies and births are often more complicated and have poorer outcomes than singleton pregnancies. We describe the pregnancies, births and outcomes for Aboriginal twins born in Western Australia (WA) and New South Wales (NSW) with comparisons to Aboriginal singletons (WA and NSW) and non-Aboriginal births (NSW).

Methods
Whole-population birth and hospital records were linked for births during 2000-2013 (WA) and 2002-2008 (NSW). Descriptive statistics are reported for demographics, maternal health, pregnancy complications, births and infant outcomes.

Results
Pregnancy complications were more common among mothers of Aboriginal twins than Aboriginal singletons (e.g. 17% of mothers of WA twins had hypertension/pre-eclampsia/eclampsia vs 8% for singletons) but similar to mothers of NSW non-Aboriginal twins. Most Aboriginal twins were born in principal referral, women’s or large public hospitals. The hospitals were often far from the mother’s home (e.g. 31% of mothers of WA Aboriginal twins gave birth at hospitals located &gt;3 hours by road from their home). Outcomes were worse for Aboriginal liveborn twins than Aboriginal singletons and non-Aboriginal twins (e.g. 58% of NSW Aboriginal twins were preterm versus 9% of Aboriginal singletons and 49% non-Aboriginal twins).

Conclusions
Mothers of Aboriginal twins faced significant challenges during the pregnancy, birth and the postnatal period in hospital.

Key messages
In addition to accessible specialist medical care, these mothers may need extra practical and psychosocial support throughout their journey.
996Factors predicting retention among people accessing outpatient methadone maintenance therapy in Tshwane, South Africa
Authors: Gloeck Natasha Rachel , Harris Bernice , Webb Elizabeth , Scheibe Andrew 
Published: September 2021

Abstract

Background
In South Africa, increasing illicit opioid use and associated health challenges can be managed with opioid substitution therapy (OST), like methadone, provided it is prescribed at the recommended dose and duration. The Community Oriented Substance Use Programme (COSUP) provides free methadone to patients with Opiod Use Disorder across Tshwane, South Africa on need-based criteria.

Methods
A retrospective cohort using secondary data of patients treated with methadone at eight COSUP sites. The factors associated with the retention of 575 participants for the period December 2016 to September 2018 were analysed.

Results
Participants on lower methadone doses had decreased odds of being retained (0 to 20mg: adjusted odds ratio (aOR) 0.25, p-value (p)=0.002, 95% Confidence Interval (CI) 0.10 - 0.61; 20 to 40mg: aOR 0.20, p &lt; 0.001, 95% CI 0.08 - 0.49). Participants receiving free methadone had 3.75 the odds to be retained (p &lt; 0.001, 95% CI 2.47 - 5.70). Inner-city participants had 5.19 the odds to be retained (p &lt; 0.001, 95% CI 2.99 - 9.03). White participants had 3.39 the odds of being retained (p = 0.001, 95% CI 1.64 - 7.00). Injecting heroin users had 0.63 the odds of being retained (p = 0.032; 95% CI 0.41 - 0.96).

Conclusions
Methadone doses above 50mg, access to free methadone, accessing care within the inner-city and the white population group were positively associated with retention. Injecting drug use was negatively associated.

Key messages
Provision of free methadone at adequate doses can aid in retaining patients within an outpatient OST programme.
1360Health impacts of a 4 month community-wide lockdown: a prospective longitudinal study in Victoria, Australia
Authors: Griffiths Daniel , Sheehan Luke , Vreden Caryn van , Petrie Dennis , Sim Malcolm , Collie Alex 
Published: September 2021

Abstract

Background
In response to the second wave of COVID-19 in Australia a 4 month community-wide lockdown resulted in Victoria, Australia. We explored the health impacts during lockdown and following its conclusion.

Methods
A cohort of 898 working-age Australians enrolled in a national longitudinal cohort study, completing surveys prior to, during, and following a Victorian lockdown during the southern hemisphere winter and early spring 2020. Mixed linear regression models examined health outcomes during and following the lockdown. Generalised estimating equations assessed changes in several determinants of health such as social interactions, engagement in work and finances.

Results
The Victorian lockdown had negative consequences for mental health and increased levels of psychological distress. These health impacts coincided with greater social isolation and cessation of work. Following the conclusion of lockdown, outcomes assessing mental health, work and social interactions had recovered to an extent whereby no significant long-lasting effects were identified compared to pre-lockdown conditions.

Conclusions
Extended community lockdowns have adverse health consequences. Governments should weigh the potential health impacts of lockdown with the benefits of reducing COVID-19 transmission. Services and programs to reduce the negative impacts of lockdown may include increases in mental health care, encouraging safe social interactions and financial support to maintain employment relationships. Longer-term follow-up is required to identify any persistent health effects of community lockdowns.

Key messages
Lockdowns result in adverse health consequences, and some quickly recover. Timely services and programs are encouraged to reduce negative impacts of lockdowns such as mental health supports and promoting safe interactions.
69Effect of smoking on treatment outcomes among newly diagnosed Tuberculosis patients in Shimla city India
Authors: Gupta Anmol , Kumar Vineet 
Published: September 2021

Abstract

Background
World health organization in 2015 had adopted “End TB Strategy” aimed at ending the global TB epidemic by 2035. Tobacco smoking has been reported to be associated with many aspects of TB disease, including increased vulnerability to being infected, recurrence with TB and related mortality.

Methods
A prospective cohort study was carried out among newly diagnosed tuberculosis patients of Shimla city which is the capital of Himachal Pradesh, a northern state of India. Data related to smoking status was collected using the standard questionnaire which was used for collection of data regarding tobacco use in Global Adult Tobacco Survey (GATS). Details of the participant’s final treatment outcomes after end of standardized treatment of 6 months was collected from the treatment records of the patients.

Results
72 TB patients were included as study subjects. The prevalence of smoking came out to be 37.5%. In our analyses, the risk of unfavorable treatment outcomes was higher among smokers (p value 0.049), Smokeless tobacco users (p value 0.031) and those with history of harmful alcohol use (p value 0.002).

Conclusions
There is high prevalence of smoking among TB patients and risk factors associated with unfavorable treatment outcome are smoking, Smokeless tobacco and history of harmful alcohol use.

Key messages
Smoking and smokeless tobacco cessation programmes need to be targeted at Tuberculosis patients. Tuberculosis patients with alcohol related problems should be identified at the time of diagnosis and should be attached with de-addiction centre
23Multiple Chronic Conditions: Need for Ongoing Research
Authors: Gupta Sangeeta 
Published: September 2021

Abstract

Background
Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC.

Methods
Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke.

Results
More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent.

Conclusions
The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance.

Key messages
Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.
1177Lest we lose focus: ongoing analyses of adverse childhood experiences in COVID-19 era
Authors: Gupta Sangeeta 
Published: September 2021

Abstract

Background
Toxic stress caused by adverse childhood experiences (ACEs) has been definitively linked to adverse health outcomes across lifespan. Prolonged COVID-19 pandemic stress affecting mental and physical health across the nation, has been postulated to amplify occurrence of ACEs and exacerbate negative health outcomes in this vulnerable population. This study provides a comparison of pre COVID (year 2019) and COVID (year 2020) data on ACE’s and health outcomes.

Methods
2019 and 2020 Behavioral Risk Factor Surveillance System data were analyzed to estimate the prevalence of childhood adversity and association with health behaviors and outcomes. Logistic regression was performed using SAS complex survey procedures.

Results
In 2019,

nearly one in four adults reported high ACE scores (≥3). High ACE scores were more prevalent among women, multiracial/minority race groups, bisexual, lesbian/gay sexually oriented, younger age group, adults, less educated, and with lower income. Comparison analyses with 2020 data has begun and is expected to be completed in time for conference presentation.

Conclusions
Ongoing focus on ACEs mitigation and/or prevention efforts is critical to better health and higher socioeconomic attainment across lifespan. COVID-19 pandemic has escalated and put a spotlight on this call . Adults with preexisting ACEs are especially vulnerable. Compounded toxic stress with limited access to health care can expedite development or worsening of chronic conditions in these susceptible groups.

Key messages
Targeted efforts to identify and protect at-risk ACEs populations from the negative impact of COVID 19 pandemic are essential.
1165Multiple Chronic Conditions: Need for Ongoing Research
Authors: Gupta Sangeeta 
Published: September 2021

Abstract

Background
Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC.

Methods
Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke.

Results
More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent.

Conclusions
The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance.

Key messages
Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.
252Development and validation of a breast cancer absolute risk prediction model in Chinese population
Authors: Han Yuting , Lv Jun , Yu Canqing , Guo Yu , Bian Zheng , Hu Yizhen , Yang Ling , Chen Yiping , Du Huaidong , Zhao Fangyuan , Wen Wanqing , Shu Xiao-Ou , Xiang Yongbing , Gao Yu-Tang , Zheng Wei , Chen Junshi , Chen Zhengming , Huo Dezheng , Li Liming 
Published: September 2021

Abstract

Background
Compared with developed countries, breast cancer in China is characterized by a rapidly escalating incidence rate, lower survival rate, and vast geographic variation. However, there is no national validated model in China to aid early detection yet.

Methods
A large nation-wide prospective cohort, China Kadoorie Biobank (CKB), was used to evaluate relative and attributable risks. A total of 300,824 women free of prior cancer were recruited during 2004-2008 and followed up to 31 December 2016. Absolute risks were calculated by incorporating national age- and residence-specific incidence and non-breast cancer mortality rates. We used an independent large prospective cohort, Shanghai Women's Health Study (SWHS), to externally validate the calibration and discriminating accuracy.

Results
During a median of 10.2 years of follow-up in the CKB, 2,287 cases were observed. The final model included education, BMI, height, family history of cancer, parity, and age at menarche. The model was well-calibrated in both the CKB and the SWHS, yielding expected/observed ratios of 1.00 (95% confidence interval (CI), 0.96-1.04) and 0.94 (95% CI, 0.89-0.99), respectively. After eliminating the effect of age and residence, the adjusted areas under the curve were 0.615 (95% CI, 0.600-0.630) and 0.585 (95% CI, 0.564-0.605), respectively.

Conclusions
Based only on non-laboratory predictors, our model has an excellent calibration and moderate discriminating capacity. The model may be a useful tool to raise individuals’ awareness and aid risk-stratified screening and prevention strategies.

Key messages
We developed a breast cancer prediction model for Chinese women, which performed well in internal and external validation.
1463Impact of missing outcome data in meta-analyses of lifestyle interventions during pregnancy to reduce postpartum-weight-retention
Authors: Harris Rebecca , Batterham Marijka , Neale Elizabeth , Ferreira Isabel 
Published: September 2021

Abstract

Background
High risk of bias associated with missing outcome data (MOD) in meta-analyses (MAs) of the effects of lifestyle interventions during pregnancy on postpartum weight retention (PPWR), casts doubt on whether such interventions can be relied upon as truly effective, since estimates are deemed valid only if MOD was missing at random (MAR).

Methods
We conducted a systematic overview of MAs to examine the impact of MOD on the estimation of meta-analytic summary intervention effects and conducted sensitivity analyses using pattern mixture models and informative missingness parameters (describing how the outcome in the missing participants may be related to the outcome in the completers), to ascertain the robustness of the estimates to reasonable deviations from the MAR assumption.

Results
Three relevant MAs were identified, all with high MOD rates in the RCTs included (median&gt;30%), and all reporting beneficial intervention effects on PPWR (in kg) estimated based on complete case analyses: [-0.78 (95%CI: -1.39,-0.16), -0.81 (-1.57,-0.06), and -0.94 (-1.52,-0.37)] in MAs of any lifestyle, exercise, or diet + exercise interventions, respectively. In plausible scenarios where the outcome for the intervention group in participants with vs without MOD was worse (by 0.5kg), effect estimates were attenuated in all and no longer significant in 2 of the MAs [-0.58 (-1.29,0.13), -0.70 (-1.50,0.10) and -0.88 (-1.73,-0.02)].

Conclusions
Statistical significance was retained when all 19 RCTs identified across MAs were meta-analysed: -0.63 (-0.17,-0.08).

Key messages
The clinical relevancy of effects of this magnitude remains unclear.
191Two approaches to teaching epidemiology online for capacity building in developing countries
Authors: Sengupta Paramita , Myles Puja , Heller Emeritus Richard 
Published: September 2021

Abstract

Background
Contributing to a mission to build Public Health capacity in developing countries, two online epidemiology courses are offered: a tutor facilitated Master’s level module ‘Introduction to Epidemiology’, and a free self-study ‘Basic Epidemiology’ Open Online Course (OOC). We report differences between these two.

Methods
Student demographics on enrolled students were abstracted. A follow-up online survey of former students was performed in January 2020.

Results
Among 772 students on the Master’s and 619 students on the OOC courses: respectively 29% and 39% were female; 36% and 38% were medical practitioners; 80% and 43% were from Africa.
For 64% of OOC students this was their first time learning online; 17% completed the course. 82% of students formally enrolled on a Master’s programme passed the module.
The majority of survey respondents reported that the courses had helped with reading articles critically (81% Master’s; 67% OOC) and improving professional practice (75% Master’s; 67% OOC); though fewer felt that the courses helped them perform their own research (67% Master’s; 51% OOC). The majority (87% Masters; 79% OOC) would recommend the course to others.

Conclusions
Online epidemiology courses have the ability to reach a wide audience in the developing world and contribute to capacity building. While both Master’s facilitated and self-study online courses were evaluated positively by students, the completion and potential impact was higher for the former.

Key messages
Online courses reaching wide audiences can help build global capacity in epidemiology
1003Modifiable risk factors and incidence of diabetes mellitus progressing in the prediabetic Population
Authors: Hong Kwan , Yu Eun Sun , Chun Byung Chul 
Published: September 2021

Abstract

Background
Although the prevention of diabetes mellitus is important, factors related to its progression in the prediabetic population are rarely revealed. This study aimed to estimate the rate of progression and uncover the modifiable risk factors leading to progression.

Methods
We constructed a group from the National Health Screening Cohort, consisting of adults who received national health screening tests in 2002. After selecting a prediabetic population, we classified them into two groups based on their diabetes progression after a 13-year follow up. The adjusted incidence rate was estimated, and the Cox proportional hazard modelling was performed to identify risk factors for progression.

Results
The progression rate of diabetes in the prediabetic population (88,330) was 22.85% (20,184), with an adjusted incidence rate of 25.18 (95% confidence interval, CI: 24.44 – 26.02) per 1,000 person-year, ages 40-64 and 25.69 (95% CI: 24.46 – 26.95) in those 65 or older. Among modifiable risk factors, smoking showed the highest hazard ratio, 1.21 (95% CI: 1.16 – 1.25), followed by BMI and alcohol consumption with hazard ratios of 1.06 (95% CI: 1.06 – 1.07) and 1.06 (95% CI: 1.02 – 1.09), respectively.

Conclusions
Considering the high progression rate of the prediabetic population, modifiable risk factors, such as smoking, should be managed.

Key messages
The progression rate of the prediabetic population was 25–26% per 1,000 person-year. At the 13-year follow up, modifiable risk factors, such as smoking, BMI, and alcohol consumption, affected the prediabetic population.
1232Relationship between leucine metabolism and executive function development: the GUSTO cohort
Authors: Huang Jian 
Published: September 2021

Abstract

Background
Molecular biomarkers for cognitive function have also been widely investigated. However, few investigated early development of executive function (EF) comprehensively, which is a higher-level of cognitive function responsible for coordinating other cognitive ability.

Methods
We investigated the metabolomic biomarkers for EF in a multi-ethnicity birth cohort in Singapore. Circulating level of 165 metabolites were quantified using a nuclear magnetic resonance (NMR)-based metabolomics platform in 457 and 524 children at age 6 and 8 years. EF was assessed in 495 children (∼7 years) using parent-reported Behavior Rating Inventory of Executive Function, Second Edition. We incorporated genetic data and performed mediation analysis to investigate the role of rs1260326 (GCKR) in the relationship between leucine metabolism and EF.

Results
Higher circulating level of leucine was consistently associated with poorer EFs (Initiate, Working Memory, Plan/Organize, Task-Monitor, and Organization of Materials) after adjusting for age, sex, maternal ethnicity, maternal educational level, household income at recruitment, and child body-mass index (BMI). Comparing to CT genotype, CC genotype in rs1260326 is potentially associated with poorer EFs. But these associations were not mediated via circulating leucine level or BMI. Higher circulating leucine exerts effect on EFs and part of the effect may be via impact on BMI. Leucine-BMI interaction may exist in CT subgroup.

Conclusions
Our analysis suggested that leucine exerts harmful effect on EF, but at a lower level, leucine-BMI interaction may counteract with the effect of leucine.

Key messages
Higher level of circulating leucine was associated with poorer EF.
Leucine-BMI interaction influences the leucine-EF association.
127Topical antibiotics used to prevent infection in the ICU: an accidental natural herd exposure experiment
Authors: Hurley James 
Published: September 2021

Abstract

Background
Multiple studies of topical antibiotics applied to ICU patients appear to show potent infection prevention effects versus studies of other interventions. However, the effect is less apparent for studies using non-concurrent (NCC) versus concurrent controls (CC) implying the possibility of a herd effect.

Methods
206 studies of infection prevention among ICU patients, sourced from 15 systematic reviews were stratified into those using topical antibiotics with NCC versus with CC versus studies of other prevention methods. The event rates were summarised using generalized estimating equations and compared to other studies without an intervention (literature benchmark).

Results
The summary effect sizes for pneumonia and mortality prevention derived in the systematic reviews were replicated.

The mean ICU mortality incidence for topical antibiotic study CC control groups (28.5%; 95% CI, 25.0-32.3; n = 41) is higher versus a literature benchmark (23.7%; 19.2%-28.5%; n = 34), versus NCC control groups (23.5%; 19.3-28.3; n = 14) and versus topical antibiotic intervention groups (24.4%; 22.1 – 26.9; n = 62). In meta-regression models adjusted for group mean age and publication year, CC group membership within a topical antibiotic study remains associated with higher mortality (p = 0.027).

Conclusions
Within topical antibiotic studies, the CC control group mortality incidences are inexplicably high, whereas the intervention group incidences are paradoxically similar to a literature-derived benchmark.

Key messages
An adverse herd effect is apparent for topical antibiotics used to prevent infection among ICU patients.