bluuebunny/crossref_metadata_2025_split huggingface dataset:
369Womeńs empowerment benefits early childhood numeracy-literacy in 26 African countries
Authors: Coll Carolina , Ewerling Fernanda , Lynch John , Raj Anita , Victora Cesar , Barros Aluisio 
Published: September 2021

Abstract

Background
Every year more than 200 million children under-five years fail to achieve their full developmental potential in low- and middle-income countries. We explored whether mothers’ empowerment is associated with early childhood development in 26 African countries.

Methods
We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys ranging from 2010 to 2018. Four developmental domains were assessed among children aged 36-59 months using the Early Childhood Development Index: literacy-numeracy, physical, learning and socioemotional. Women’s empowerment in attitude to violence, social independence and decision-making was evaluated using the SWPER Global, a validated survey-based index. We used logistic regression to estimate the associations between mother’s empowerment level in each domain and the development of their children controlled by wealth.

Results
Across all countries, 15·1% of the children were on track in the literacy-numeracy domain, 92·3% in physical, 81·3% in learning and 67·8% in socio-emotional. The odds of a child being on track in literacy-numeracy increased by 11%, 34% and 18%, with a one standard deviation increase in the scores of attitudes to violence, social independence and decision-making domains of empowerment, respectively. No effect of empowerment was observed for the other domains of child development in most countries.

Conclusions
We found a consistent and positive effect of mothers’ empowerment on the literacy-numeracy domain of child development. The null effects in other developmental domains may be related to lower variability in these outcomes, or to specific effects on literacy-numeracy.

Key messages
Womeńs empowerment has a potential to improve child development and their future human capital
613Monitoring chronic kidney disease evolution using frailty models
Authors: Ferreira Renato , Colugnati Fernando 
Published: September 2021

Abstract

Background
Frailty models improves traditional survival models such that a latent multiplicative effect is introduced on the risk function, representing non-observed characteristics such as genetic and behavioral. The aim of this study is to explore this kind of model on chronic kidney disease (CKD) monitoring for intermediary outcomes.

Methods
Using a retrospective cohort comprising 778 patients with diagnosed CKD, parametric survival models were adjusted for the months until decay of renal function ≥5mL as outcome. Models included diabetes, hypertension and CKDEPI as covariates. Latent effect were incorporated, with Gamma distribution, to the best model.

Results
Just diabetes presented relevant effect on outcome. Best model were Weibull. Without frailty component, estimated diabetes parameter was 0.70 (CI95% 0.54; 0.89), indicating diabetic patients present outcome 30% earlier than non-diabetic. When incorporating the Gamma fragility to the models, the effect was 0.75, (CI95% 0.61, 0.92), or 25% faster on diabetes. The 5 percent points difference between parameters on both models represent, on average, a 20-day difference, having the survival median time of 13 months as reference. It’s possible to address individual specific frailty, an important feature for clinical follow-up.

Conclusion
Including frailty on modeling made possible to know that in average diabetic patients would experience a fast decay in renal function earlier than what a traditional survival model could evidence. This may be crucial for clinical decision making. All models were adjusted using commercial software.

Key message
Modern clinical epidemiology must foster use of modern statistics
1370Introducing network analysis to measure early life adversity
Authors: De Vries Tjeerd Rudmer , Arends Iris , Rod Naja Hulvej , Oldehinkel Albertine J. , Bültmann Ute 
Published: September 2021

Abstract

Focus of Presentation
Many studies have investigated associations between early life adversity (ELA) and outcomes across the life course. A defining characteristic of ELA is its complex nature, as many individual adverse experiences (e.g., parental mental health problems, financial difficulties) co-occur and interact over time. Commonly used methods for measuring ELA have not been able to elucidate pathways through which individual AEs are associated with each other during early life. We propose using network analysis to overcome this research gap.

Findings
Figure 1 shows the conditional associations between AEs in childhood and adolescence in an undirected network model, based on empirical data from the longitudinal TRAILS cohort. First, we found that the network model allows us to explain co-occurrences between AEs. For example: the co-occurrence of parental illness and financial difficulties in childhood is likely due to parental unemployment. Second, we identified which AEs are associated over time, e.g., familial conflicts in childhood and adolescence are strongly associated, the latter being associated with parental divorce in adolescence.

Conclusions/Implications
These findings add to the literature by providing insight into how individual AEs are conditionally associated, in distinct developmental periods and over time. The findings can be used in future research on pathways between AEs and guide the development of interventions.

Key messages
Undirected network models are a promising alternative approach to measuring ELA that can provide insight into pathways through which AEs co-occur and interact over time.
787Multistate modelling to investigate the impact of recurrent malaria episodes on hospital admissions and mortality
Authors: Dini Saber , Douglas Nicholas , Poespoprodjo Jeanne Rini , Kenangalem Enny , Sugiarto Paulus , Plumb Ian , Price Ric , Simpson Julie 
Published: September 2021

Abstract

Background
Inadequate prevention and treatment of malaria can lead to reinfections and recurrent episodes, and for vivax malaria, further recurrences from the dormant liver stage. This study quantified the impact of recurrent malaria episodes on morbidity and mortality.

Methods
Routinely collected data were available from 68,381 malaria patients presenting to the primary referral hospital in Papua, Indonesia. A multi-state modelling framework, with Cox regression for transition rates, was employed to determine the risks of re-presentation to hospital, receiving in-patient treatment, and early (≤14 days post treatment)/late death following multiple malaria episodes.

Results
The risk of re-presentation to hospital increased from 34.7% (95%CI: 34.4%–35.1%) at first episode to 58.6% (57.5%–59.6%) following the third episode. Infection with vivax malaria increased the rate of re-presentation to hospital by 1.48-fold (Hazard Ratio 1.48; 95%CI 1.44–1.51) and late hospital in-patient admission by 1.17-fold (1.11–1.22), compared to falciparum. Falciparum malaria caused a higher overall rate of early death (1.54 (1.25–1.92)), however, after multiple episodes, there was a trend towards a greater rate of early death for vivax infection (1.91 (0.73–4.97)).

Conclusions
Recurrent episodes of malaria can cause substantial morbidity and mortality, highlighting the importance of prevention and effective treatments for both falciparum and vivax malaria.

Key messages
To achieve elimination of malaria in South-East Asia, where prevalence of vivax malaria is high, we must prioritise the radical cure of vivax to eliminate the liver-stage of this species that causes relapses of infection.
1274The application of simulation to quantifying the influence of bias in reproductive and perinatal epidemiology
Authors: Dunne Jennifer , Tessema Gizachew Assefa , Ognjenovic Milica , Pereira Gavin 
Published: September 2021

Abstract

Background
Establishing causal effects in reproductive and perinatal epidemiology is challenging due to the many selection and attrition processes from preconception to the postnatal period. Further challenging, is the potential for the misclassification of exposures, outcomes and confounders, contributing to measurement error. The application of simulation enables the illustration and quantification of the magnitude of various types of bias commonly found in observational studies.

Methods
A systematic search was conducted in PubMed, Medline, Embase, CINAHL and Scopus in August 2020. A gray literature search of Google and Google Scholar, followed by a search of the reference lists of included studies, was undertaken.

Results
Thirty-nine studies, covering information (n = 14), selection (n = 14), confounding (n = 9), protection (n = 1), and attenuation bias (n = 1) were identified. The methods of simulating data and reporting of results varied, with more recent studies including causal diagrams. Few studies included code for replication. Although there has been an increasing application of simulation in reproductive and perinatal epidemiology since 2015, overall this remains an underexplored area.

Conclusions
The studies demonstrated effectiveness in the quantification of multiple types of bias using simulation. The limited use implies that further effort is required to increase knowledge of the application of simulation, which will thereby improve causal interpretation in reproductive and perinatal studies.

Key messages
Practical guidance for researchers is required in the development, analysis and reporting of simulation methods for the quantification of bias.
1090The Brazilian farm-to-school regulatory policy: local governance correlates
Authors: Duran Ana Clara 
Published: September 2021

Abstract

Background
We explored whether local governance tools related to participatory democracy were associated with a better implementation of a farm-to-school regulation, which states that 30% of procured foods for the Brazilian National School Feeding Program (BNSFP) must come from family farming.

Methods
Longitudinal study with data on federal transfers to all Brazilian municipalities (n = 5.570) for the BNSFP from 2011 to 2017. The outcome was the percentage of those transfers used to procure foods from family farming. Participatory democracy measures included the presence of sectoral school feeding program councils and adherence to the National Food and Nutrition Security System (NFNS). Models were adjusted for total federal transfers to support family farming; the importance of federal transfers to the local economy; changes in land coverage devoted to family farming; municipal gross domestic product, and population size. We employed year and municipality fixed-effect linear models with clustered standard errors at the state level.

Results
Procurement from family farming rose from 16.5% [95%CI 16.0,17.0] in 2011 to 32.2% [95%CI 31.0, 33.5] in 2017. The presence of local sectoral school feeding program councils and local adherence to the NFNS were associated with a greater increase in the percentage of foods procured from family farming.

Conclusions
Local participatory democracy was associated with a better implementation of the farm-to-school regulation in Brazil.

Key message
Local participatory democracy measures influenced the implementation of the Brazilian national farm-to-school regulation. Our findings can help inform similar policies in other countries.
684Childhood Risk Factors and Adult Cardiovascular Disease Outcomes The International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Dwyer Terence , Raitakari Olli T. , Jacobs David , Woo Jessica G. , Urbina Elaine M. , Bazzano Lydia , Juonala Markus , Viikari Jorma , Chen Wei , Prineas Ronald , Steinberger Julia , Daniels Stephen , Sinaiko Alan , Venn Alison , Burns Trudy L. , Hu Tian 
Published: September 2021

Abstract

Background
Atherosclerosis develops silently for decades before adult cardiovascular disease (aCVD) occurs. There is currently no evidence directly linking childhood risk factors to aCVD outcomes.

Methods
i3C is an international consortium of 7 cohorts involving 40,709 participants enrolled between 1970-95 in childhood (age 3-19) who underwent measurement for BMI, SBP, total cholesterol, and triglycerides, and smoking (the last mostly in adolescence). Participants were followed by direct contact and review of medical records or death registry ascertainment through adulthood in 2014-19. 20,560 participants were found and interviewed or had died in the approximately 40 years since enrollment; 738 had a CVD event, confirmed by medical record review (n = 449) or death certificate ICD code (n = 289).

Results
Estimated hazard ratios (HRs) for childhood risk factors and their confidence intervals are displayed in the table below. The CIs excluded 1.0 for all these variables in the univariable analysis and, although the HRs were reduced in multivariable analysis which included all of these risk factors, the CIs still excluded 1.0.

Conclusion
Exposure to CVD risk factors in youth predicts adult CVD with implications for primordial CVD prevention.

Key messages
Intervention to reduce CVD risk factors in childhood is likely to reduce risk of adult CVD
1055The applicability of the Healthy Eating Index to measure Iranian diet quality
Authors: Ebrahimi Sara , Leech Rebecca , McNaughton Sarah , Livingstone Katherine 
Published: September 2021

Abstract

Background
Iranian diet quality has been evaluated using indices that are not based on Iranian dietary guidelines. This study examined the applicability of the Healthy Eating Index (HEI) by examining associations with sociodemographics, nutrient intakes and nutrient adequacy.

Methods
Household sociodemographics and dietary intakes (three 24-h dietary recalls) were collected in the cross-sectional National Comprehensive Study on Household Food Consumption Patterns and Nutritional Status 2001-2003. Household diet quality was calculated using the HEI. Regression analyses examined associations between diet quality and sociodemographics, nutrient intakes and nutrient adequacy.

Results
A total of 6584 households were included in this study. Age (β-coeff 2.11; 95% CI: 1.64, 2.44), education (β-coeff 4.58; 4.05, 5.11) and living in urban areas (β-coeff 2.87; 2.56, 3.19) (as reported by the household head) were positively associated with diet quality. Higher diet quality was associated with higher intake of protein (% energy) (β-coeff 0.08; 0.07, 0.08), calcium (mg/day) (β-coeff 12.10; 11.23, 12.98), iron (mg/day) (β-coeff 0.04; 0.02, 0.05), vitamin C (mg/day) (β-coeff 3.61; 3.45, 3.77) and fibre (g/day) (β-coeff 0.12; 0.11, 0.14), lower intake of sodium (mg/day) (β-coeff -83.45; -93.02, -73.88) and adequate intake of calcium (mg/day) (OR 1.10; 95% CI: 1.09, 1.12) and vitamin C (mg/day) (1.19; 1.18, 1.20).

Conclusions
Higher HEI was associated with a range of sociodemographics and better nutrient intakes and nutrient adequacy.

Key messages
HEI was applicable for assessing the diet quality of Iranian households.
443Factors associated with frailty in a relatively healthy community-dwelling older adults
Authors: Ekram A R M Saifuddin , Ryan Joanne , Espinoza Sara , Newman Anne , Murray Anne , Orchard Suzanne , Fitzgerald Sharyn , Ernst Michael , Woods Robyn 
Published: September 2021

Abstract

Background
Frailty is gaining importance as a predictor of disability and mortality in aged adults, and becoming frail poses a challenge for healthy aging. We investigated the prevalence and factors associated with pre-frail and frail status in a large study cohort of community-dwelling healthy older adults from Australia and the United States.

Methods
A total of 19,114 individuals (87% Australian and 56% women) aged 65 years or older enrolled in a primary prevention clinical trial were evaluated. Frailty status was classified using the modified Fried phenotype criteria comprising exhaustion, body mass index, grip strength, gait speed and physical activity. Prevalence and factors associated with frailty status (e.g., demographic characteristics and lifestyle factors) were reported using descriptive statistics along with a logistic regression model.

Results
At baseline, 39.0% (95% CI: 38.3, 39.7) of older trial participants were pre-frail and 2.2% (95% CI: 2.0, 2.4) were frail, respectively. Women were more likely to be frail (65.1% vs. 36.9%) and prefrail (58.0% vs. 42.0%) than men. Lower levels of education (&lt;12 years), living alone, ethnic minorities, current smoking and past alcohol use were some of the factors which were common among frail or prefrail.

Conclusions
Despite being a relatively healthy cohort, more than one-third of the older trial participants were pre-frail, which was more prevalent among specific subgroups of individuals. This study emphasizes the high burden of the prefrailty status even among a healthy cohort of community-dwelling older people.

Key messages
The burden of prefrailty is high, even among a healthy cohort of older people in the communities.
22A Survey-Based Women's Empowerment Index for Low- and Middle-Income Countries: The SWPER Goes Global
Authors: Ewerling Fernanda , Raj Anita , Victora Cesar G , Hellwig Franciele , Coll Carolina VN , Barros Aluisio JD 
Published: September 2021

Abstract

Background
In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions.

Methods
We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII).

Results
Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI.

Conclusions
The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.
904Physical fitness across the life-course and the metabolic syndrome in mid-adulthood
Authors: Fraser Brooklyn , Blizzard Leigh , Buscot Marie-Jeanne , Schmidt Michael , Dwyer Terence , Venn Alison , Magnussen Costan 
Published: September 2021

Abstract

Background
Low physical fitness, including muscular strength and cardiorespiratory fitness (CRF), is a risk factor for the metabolic syndrome (MetS). However, it is unknown how physical fitness at different life stages contributes to the development of MetS.

Methods
Included were 783 Childhood Determinants of Adult Health Study participants who between 1985 and 2019 had measures of physical fitness (muscular strength: dominant grip strength; CRF: 1.6km run or physical work capacity at 170 beats per minute) at three life stages (childhood=7–15 years, young-adulthood=26–36 years, mid-adulthood=36–49 years) and had their MetS status assessed using the harmonised definition in mid-adulthood. The Bayesian relevant life-course exposure model, a novel statistical analytic technique, quantified associations between physical fitness at each life stage with MetS and estimated the maximum accumulated effect of physical fitness across the life-course.

Results
The contribution of muscular strength at each life stage with MetS in mid-adulthood was equal (childhood=36%, young-adulthood=31%, mid-adulthood=33%), whereas for CRF the greatest contribution was from childhood and mid-adulthood (childhood=41%, young-adulthood=20%, mid-adulthood=39%). A one standard deviation increase in cumulative physical fitness across the life-course was associated with 36–55% reduced odds of MetS (muscular strength: OR = 0.64, 95%Credible Interval=0.40,0.95; CRF: OR = 0.45, 95%Credible Interval=0.30,0.64).

Conclusions
As physical fitness at each life stage was associated with MetS in mid-adulthood, strategies aimed at increasing both childhood and adult physical fitness levels could improve future health.

Key messages
Increased participation in both aerobic and muscle-strengthening activities, beginning in childhood and extending into adulthood, could be encouraged to help prevent MetS.
367Association between dietary fatty acid intake, serum levels of fatty acids and ABCA1 DNA methylation
Authors: Fujii Ryosuke , Yamada Hiroya , Munetsuna Eiji , Yamazaki Mirai , Mizuno Genki , Ando Yoshitaka , Maeda Keisuke , Tsuboi Yoshiki , Ohashi Koji , Ishikawa Hiroaki , Hagiwara Chiharu , Wakai Kenji , Hashimoto Shuji , Hamajima Nobuyuki , Suzuki Koji 
Published: September 2021

Abstract

Background
Although previous studies have demonstrated that n-3 polyunsaturated fatty acids (PUFA) are inversely associated with a risk of CVD through gene expression, recent evidence suggests that it may arise from changes in DNA methylation. Therefore, we investigated whether dietary FA intake and serum FA levels are associated with ATP-binding cassette transporter A1 (ABCA1), a gene associated with HDL-cholesterol metabolism.

Methods
A total of 298 subjects (137 men, mean age of 63.2) without clinical history and medication participated in this cross-sectional study. We used the pyrosequencing method to measure DNA methylation levels at 8 CpG sites within ABCA1 gene and calculated mean DNA methylation level. Dietary FA intake were assessed with the food frequency questionnaire.

Results
We found that ABCA1 DNA methylation levels were significantly lower with higher dietary intake of n-3PUFA (β = –5.75, p = 0.001), which is observed both in men (β = –4.85, p = 0.001) and women (β = –7.24, p = 0.007). In addition, ABCA1 DNA methylation levels were significantly lower with higher serum levels of n-3PUFA in men (β = –2.78, p = 0.05), but not in women (β = 1.61, p = 0.31).

Conclusions
The results suggest that higher dietary n-3 PUFA intake and serum levels of n-3 PUFA are associated with lower ABCA1 DNA methylation in a Japanese population.

Key messages
Higher dietary n-3 PUFA intake can be a prevention from dyslipidemia and CVD via low level of ABCA1 DNA methylation