Estimate Prevalence Ratios Research Articles

HIV Pre-Exposure Prophylaxis (PrEP) awareness and use among Rakai Community Cohort Study youth aged 15-24.

Preventing HIV infections among adolescents and young adults (AYA) is crucial for curtailing the epidemic. Oral pre-exposure prophylaxis (PrEP) is a highly effective prevention method increasingly available to this age group in sub-Saharan Africa but population-based data on awareness and use of PrEP among AYA remains limited. Analyzing survey data from two rounds of the Rakai Community Cohort Study, an open, population-based cohort, we estimated prevalence ratios associating various sociodemographic characteristics with PrEP awareness and ever-use among 15- to 24-year-olds in south-central Uganda between 2018 and 2023. Most (62.4%, N=3,308/5,301) participants were aware of PrEP as an HIV prevention method but only 1.7% (N=133/7,999) of AYA had ever used it. Among the 35.5% (N=2,838/7,999) of participants meeting PrEP eligibility criteria, ever-use was similarly rare (2.6%, N=75/2,838). Compared to 20 to 24-year-olds, 15 to 19-year-olds were less likely to report awareness (fullyadjPR=0.82, 95%CI 0.78, 0.86) or ever-use (fullyadjPR=0.35, 95%CI 0.21, 0.58). Participants from fishing communities were more likely to be PrEP-aware (fullyadjPR=1.22, 95%CI 1.16, 1.29) or have ever used the prevention method (fullyadjPR=6.07, 95%CI 4.10, 8.98) than those from non-fishing communities. In this cross-sectional study of AYA in Uganda, awareness of PrEP was common but ever-use was rare, even among the third of respondents who were likely PrEP-eligible. This suggests that prevention policies and barriers besides unawareness of the method impede PrEP initiation. Efforts that target those barriers, particularly for adolescents, are critical for reducing HIV incidence among this priority population.

Maternal HIV retesting during antenatal care in selected health facilities in Mayuge district, Uganda: A cross-sectional study.

Vertical transmission of HIV continues to be a key contributor to pediatric HIV infections globally. Routine HIV testing at each antenatal care (ANC) visit can reduce the likelihood of such infections. However, a sub-optimal number of women are re-tested for HIV on their subsequent ANC visits. This study determined the proportion of pregnant women who were retested during ANC and the associated factors in selected health facilities in Mayuge district, Uganda. This was a cross-sectional study that utilized quantitative data collection techniques among 344 randomly selected women recorded as HIV-negative at their first ANC visit in 2022 from records at selected health facilities in Mayuge district. A semi-structured questionnaire designed in Kobo Collect software was utilized to collect the data. The data were collected through in-person interviews or by phone. Descriptive data were reported for the sample, and multivariable modified Poisson regression models were fitted to estimate prevalence ratios for factors associated with HIV re-testing. Out of 344 women attending ANC, 18.6% (64/344) had been retested for HIV. The factors associated with HIV retesting included attending ANC in the second trimester (APR = 0.62; 95%CI:0.40-0.98), attending at least four ANC visits (APR = 2.24; 95% CI:1.22-4.09), having a planned pregnancy (APR = 1.96; 95%CI: 1.14-3.37), being satisfied with the quality of health services provided (APR = 1.79; 95%CI: 1.05-3.04), and having easily accessible HIV testing resources at the ANC clinic (APR = 2.04; 95%CI: 1.08-3.85). HIV retesting during ANC in Mayuge district was low and mostly influenced by ANC-related factors at the individual and systems levels. These factors ought to be addressed to improve the uptake of maternal HIV retesting.

Impact of TCF7L2 rs7903146 on clinical presentation and risk of complications in patients with type 2 diabetes.

TCF7L2 rs7903146 is the most impactful single genetic risk variant for type 2 diabetes. However, its role on disease progression, complications and mortality among people with type 2 diabetes at diagnosis remains unclear. We assessed the per allele impact of the rs7903146 T-allele on clinical characteristics and complication risk in 9231 individuals with type 2 diabetes at diagnosis and over a 10-year follow-up period. Log-binomial and robust Poisson regression analyses were used to estimate prevalence ratios for clinical characteristics and macro- and microvascular complications at diabetes onset, while Cox regression was applied to estimate the risk of complications post-diagnosis. Analyses were adjusted for sex, calendar year at birth, age at enrollment and diabetes duration. The per T-allele impact was associated with 0.6 kg/m2 (95% CI: 0.4, 0.8) lower BMI, 1.4 cm (95% CI: 1.0, 1.8) smaller waist circumference, 5.6% (95% CI: 4.2, 7.0) lower insulin secretion and 5.0% (95% CI: 3.3, 6.7) higher insulin sensitivity. Over 10 years, the per T-allele impact was associated with lower risks for major adverse cardiovascular events (0.87 [95% CI 0.79, 0.95]), myocardial infarction (0.82 [95% CI: 0.72, 0.93]) and heart failure (0.85 [95% CI 0.73, 1.00]), with no significant impact on microvascular complications. The TCF7L2 variant is associated with less obesity, lower insulin secretion and higher insulin action at diabetes onset, and decreased risk of cardiovascular events following type 2 diabetes onset.

Self-reported illnesses in Thatta: Evidence from a rural and underdeveloped district in Sindh province, Pakistan.

Self-reported illnesses (SRI) surveys are widely used as a low-cost substitute for weak Disease Surveillance Systems in low- and low-middle-income countries. In this paper, we report findings of a district-level disease prevalence survey of all types of illnesses including chronic, infectious, injuries and accidents, and maternal and child health in a rural district in Pakistan. A district-level survey was conducted in Thatta in 2019 with a population-representative sample of all ages (n = 7811) a. Survey included questions on demographics and SRIs from the respondents. Prevalence was estimated for all SRIs categorized into six major and 16 minor illnesses. The influence of important socio-demographic covariates on the illnesses and multiple comorbidities was explored by estimating prevalence ratios with a Generalized Linear Model of the Poisson family and by Zero-Inflated Poison Distribution respectively. 36.57% of the respondents to the survey reported at least one SRI. Prevalence of communicable illnesses was 20.7%, followed by non-communicable illnesses (4.8%), Gastrointestinal disorders (4.4%), and injuries/disabilities (1.9%). Urban inhabitants were more likely to have Chronic Obstructive Pulmonary Disorders (3.34%) and Diabetes (1.62%). Females were most likely to have injuries (1.20,), disabilities (1.59), and Musculoskeletal Disorders (1.25). Children aged < 1 year (0.80) and elderly >65 years (0.78) were more likely to have comorbidities. Our estimated prevalence of SRI is quite higher than the prevalence of unknown SRIs in national-level surveys in Pakistan. This research's findings serve as an example of aiding evidence-based priority settings within the health sector. Our findings on gender, and young and old age as positive predictors of SRI are consistent with similar surveys in a few LMICs. We provide evidence of a complete disease profile of a district that is otherwise unavailable in the country. This study can reshape the existing health surveys and to aid evidence-based priority settings in the health sector. We, however, support strengthening the Disease Surveillance System as a reliable source of disease prevalence data.

Assessing a bundle of peer counseling, mobile phone messages, and mama kits in promoting timely initiation of and exclusive breastfeeding in Uganda: A cluster randomized controlled study.

Timely initiation of and exclusive breastfeeding have been recommended as key interventions to enable countries to attain the sustainable development target of reducing neonatal mortality to no more than 12 deaths per 1000 live births and to reduce mortality of children under 5 years to no more than 25 deaths per 1000 live births. We conducted a cluster randomized controlled trial with the main objective to assess the effect of an integrated package consisting of: peer counseling, mobile phone messages, and mama kits on promoting health facility births between January 2018 and February 2019, in Lira district, Northern Uganda. In this article, we assessed the effect of the intervention on our two secondary objectives: timely initiation of and exclusivity of breastfeeding. We used a generalized estimation equation of the Poisson family, with a log or identity link, taking clustering into account to estimate prevalence ratios and prevalence differences. A total of 64% (594/926) of participants in the intervention arm initiated breastfeeding within the first hour after birth compared to 60% (493/829) in the control arm. The proportion of participants in the intervention arm that initiated breastfeeding within the first hour of life did not significantly differ from that in the control arm [Prevalence Ratio (PR) 1.08 (0.97 to 1.21)] and [Prevalence Difference (PD) 0.05 (-0.02 to 0.12)]. When we restricted the analysis to only mothers who decided on when to breastfeed, there was some evidence of intervention effectiveness [PR 1.20, 95% CI (0.99-1.5)]. In the intervention arm, 89% (804/904) of participants exclusively breastfed their infants in the first month of life compared to 81% (656/813) in the control arm. Participants in the intervention arm were 10% more likely to have exclusively breastfed in the preceding 24 hours compared to mothers in the control arm [PR 1.10 (1.04 to 1.17)] and [PD 0.08 (0.04 to 0.13)], and 16% more likely to have exclusively breastfed since birth compared to mothers in the control arm [PR 1.16 (1.03 to 1.30)] and [PD 0.12 (0.03 to 0.20]. The intervention improved the proportion of mothers who practiced exclusive breastfeeding in the first month of life, but did not increase the proportion of mothers who initiated breastfeeding in the first hour of life. Future breastfeeding promotion interventions should consider including a health facility component and improving maternal autonomy to promote timely initiation of breastfeeding.

Volatile hydrocarbon exposures and immune-related illnesses among Deepwater Horizon oil spill workers.

Despite evidence from experimental studies linking some petroleum hydrocarbons to markers of immune suppression, limited epidemiologic research exists on this topic. The aim of this cross-sectional study was to examine associations of oil spill related chemicals (benzene, toluene, ethylbenzene, xylene, and n-hexane (BTEX-H)) and total hydrocarbons (THC) with immune-related illnesses as indicators of potential immune suppression. Subjects comprised 8601 Deepwater Horizon (DWH) oil spill clean-up and response workers who participated in a home visit (1-3 years after the DWH spill) in the Gulf Long-term Follow-up (GuLF) Study. Cumulative exposures to THC and individual BTEX-H constituents during the oil spill clean-up were estimated using a job-exposure matrix linking air measurement data to detailed participant work histories. Study outcomes included post-spill occurrence and/or frequency of illnesses ascertained at the home visit, including colds, flu, cold sores, pneumonia, and shingles. Frequent cold and frequent flu were defined as ≥4 colds and ≥2 episodes of flu since the spill, respectively. We examined an aggregate outcome of frequent colds, any flu, cold sores, or pneumonia since the spill. In single pollutant models, we used multivariable log-binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for associations between quartiles of THC and BTEX-H exposures with each outcome. We used quantile g-computation to estimate the joint effect of the BTEX-H mixture. We observed positive associations of increasing quartiles of THC and BTEX-H with all outcomes except shingles, with evidence of an exposure-response for most outcomes. Strongest associations were observed for frequent flu (range of PR: 1.41-1.67). The BTEX-H mixture was associated with small to modest elevations in PRs for most outcomes. This study is the first to our knowledge to demonstrate an association between oil spill BTEX-H exposures and multiple immune-related illnesses as measures of potential immune suppression. Increasing oil spill-related volatile hydrocarbon exposures may increase the risk of multiple immune-related illnesses, especially frequent cold and frequent flu. Future research on this topic using more robust measures of immune function would advance existing evidence on this relationship.

The Prevalence of Multidrug Resistance in Enterobacterales Is Higher in Patients Undergoing Hematopoietic Stem Cell Transplantation.

Antimicrobial resistance is a global public health emergency. Patients undergoing hematopoietic stem cell transplantation (HCT) are at increased risk for severe infections with multidrug-resistant (MDR) organisms, although more data are needed on the relative burden of MDR Enterobacterales (MDR-E) in immunocompromised populations. In this study, we compare the prevalence of Enterobacterales resistance in cultures from patients undergoing HCT with that of non-HCT patients seeking care at a large healthcare system in North Carolina, USA. We analyzed electronic health data from 52 067 patients aged ≥18 years with a culture positive for Enterobacterales species (2000-2023). Of these, 271 had undergone HCT prior to culture-recovered Enterobacterales. We compared resistance trends over time for specific antibacterial classes using a 5-year moving average and used generalized linear models to estimate prevalence ratios and differences of MDR-E in HCT versus non-HCT patients. HCT recipients overall had a higher prevalence of MDR-E (37.7% vs 19.4%) and resistance for all individual antibiotic classes analyzed. Comparing HCT vs non-HCT groups, the highest prevalence ratio was observed for resistance to aminoglycosides (2.10 [95% confidence interval {CI}, 1.65-2.68]); the largest adjusted absolute difference in nonsusceptibility was observed with quinolones (20.4 [95% CI, 14.9-25.8]). MDR-E infections were associated with double all-cause mortality at 1 year. This large longitudinal study highlights how antimicrobial resistance has consistently been a substantial problem in HCT recipients over the prior 2 decades. Targeting antimicrobial resistance mitigation efforts will be key in reducing the risk of MDR infections in HCT.

Pre-diagnosis and pre-treatment loss to follow-up and associated factors among patients with presumed tuberculosis and those diagnosed in Uganda

BackgroundLoss to follow-up (LTFU) of patients with presumed tuberculosis (TB) before completing the diagnostic process (pre-diagnosis LTFU) and before initiating treatment for those diagnosed (pre-treatment LTFU) is a challenge in the realization of the End TB Strategy. We assessed the proportion of pre-diagnosis and pre-treatment LTFU and associated factors among patients with presumed TB and those diagnosed in the selected health facilities.MethodsThis was a retrospective cohort study involving a review of routinely collected data from presumptive, laboratory and TB treatment registers from January 2019 to December 2022. The study was conducted in three general hospitals and one lower-level health center IV in Central Uganda. We defined pre-diagnosis LTFU as failure to test for TB and obtain results within 30 days from the date of being presumed and pre-treatment LTFU as failure to initiate TB treatment within 14 days from the date of diagnosis. Modified Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of factors associated with pre-diagnosis and pre-treatment LTFU.ResultsOf the 13,064 patients with presumed TB, 39.9% were aged 25 to 44 years, and 57.1% were females. Almost a third, 28.3% (3,699/13.064) experienced pre-diagnosis LTFU and 13.7% (163/1187) did not initiate treatment within 14 days from being diagnosed. Pre-diagnosis LTFU was more likely to occur among patients aged 0-14 years (adj PR 1.1, 95% CI: 1.06,1.24), females (adj.PR=1.06, 95% CI: 1.01, 1.12) and those with no record of place of residence (adj. PR=2.7, 95% CI: 2.54, 2.93). In addition, patients with no record of phone contact were more likely to be LTFU, (adj. PR=1.1, 95% CI: 1.05, 1.17). Pre-treatment LTFU was also more likely among patients with no record of place of residence (adj PR 7.1, 95% CI: 5.13,9.85) and those with no record of phone contact (adj PR 2.2, 95% CI: 1.63,2.86). Patients presumed from the HIV clinics were 40% less likely to experience pre-treatment LTFU compared to those in the outpatient departments (adj PR 0.6, 95% CI: 0.41,0.88).ConclusionHigh proportions of pre-diagnosis and pre-treatment LTFU were observed in this study. This calls for urgent interventions at these time points in the TB care cascade to be able to realise the End TB Strategy.

The role of dentate status and dental caries on diabetes-related complications: a hospital-based cross-sectional study.

This study explored the role of dentate status and dental caries on diabetes-related complications among patients with type 2 diabetes mellitus (T2DM). A hospital-based cross-sectional design was applied to collect data on diabetic patients attending integrated services for non-communicable diseases and oral health at a public hospital in Thailand. Diabetic complication outcomes included diabetic eye and foot complications and chronic kidney disease (CKD). The main independent variable of dentate status and dental caries was classified into three categories: dentate and caries-free, dentate with caries, and edentulous. The relationships were evaluated through epidemiological models depicted by directed acyclic graphs (DAGs). Multivariable Poisson regression with robust standard errors was applied to estimate prevalence ratios (PR) according to DAGs. Among 438 patients with T2DM, 62.8% were women, and an average age was 63.6 years. Most patients were dentate with dental caries (70.1%), and 8.2% were edentulous. Prevalence of diabetic foot complications and CKD were 37.1% and 10.1%. Six patients had eye complications. Regarding CKD outcome, PR estimates from univariable and multivariable models were 0.94-1.12 for the dentate with caries group and 1.67-2.31 for the edentulous group, all with non-significant P values. Regarding foot complication outcome, PR estimates were 1.10-1.12 for the dentate with caries group and 1.26-1.37 for the edentulous group, all with non-significant P values. Though not statistically significant, the magnitude and direction of PR suggested a possible hypothesis that, among patients with T2DM, edentulism might be related to a higher prevalence of CKD and diabetic foot complications as compared to being dentate and caries-free.

Effect of pneumococcal conjugate vaccination on pneumococcal carriage in hospitalised children aged 2–59 months in Mongolia: an active pneumonia surveillance programme

Data on changes in pneumococcal serotypes in hospitalised children following the introduction of the pneumococcal conjugate vaccine (PCV) in low-income and middle-income countries are scarce. In 2016, Mongolia introduced the 13-valent PCV (PCV13) into the national immunisation programme. We aimed to describe the trend and impact of PCV13 introduction on pneumococcal carriage in hospitalised children aged 2-59months with pneumonia in Mongolia over a 6-year period. In this active surveillance programme, children aged 2-59months with pneumonia who met the study case definition (cough or difficulty breathing with either respiratory rate ≥50beats per min, oxygen saturation <90%, or clinical diagnosis of severe pneumonia) were enrolled between April 1, 2015, and June 30, 2021, from four districts in Ulaanbaatar. We tested nasopharyngeal samples collected at enrolment for pneumococci using lytA real-time quantitative PCR and conducted molecular serotyping and detection of antimicrobial resistance (AMR) genes with DNA microarray. We used log-binomial regression to estimate prevalence ratios (PRs) of pneumococcal carriage, comparing prevalence in the periods before and after the introduction of PCV13 and between vaccinated and unvaccinated children for three outcomes: overall, PCV13 vaccine-type, and non-PCV13 vaccine-type carriage. PRswere adjusted with covariates that were identified by use of a directed acyclic graph, informed by relevant literature. A total of 17 688 children were enrolled, of whom 17 607 (99·5%) met the study case criteria. 6545 (42·5%) of 15 411collected nasopharyngeal swabs were tested for pneumococci. In all age groups, a similar prevalence of pneumococcal carriage was shown between the pre-PCV13 period and post-PCV13 period (882 [48·0%] of 1837 vs 2174[46·2%] of 4708; adjusted PR 0·98 [95% CI 0·92-1·04]; p=0·60). Overall, vaccine-type carriage reduced by43·6% after the introduction of PCV13 (adjusted PR 0·56 [95% CI 0·51-0·62]; p<0·0001). Younger children (aged 2-23months) showed a 47·7% reduction in vaccine-type carriage (95% CI 41·2-53·5; adjusted PR 0·52 [95% CI 0·46-0·59]; p<0·0001), whereas children aged 24-59months had a 29·3% reduction (12·6-42·8; 0·71[0·57-0·87]; p=0·0014). Prevalence of 6A, 6B, 14, 19F, and 23F decreased following the introduction of PCV13; however, 19F and 6A remained common (5·8% and 2·9%). Non-vaccine-type carriage increased (adjusted PR 1·49[95% CI 1·32-1·67]), with 15A, NT2, and 15B/C being the most prevalent serotypes. Overall, 1761 (89·3%) of 1978analysed samples contained at least one AMR gene. The percentage of samples with any AMR gene decreased with vaccine introduction (92·3% in the pre-PCV13 period vs 85·3% in the post-PCV13 period; adjusted odds ratio 0·49 [95% CI 0·34-0·70]), with similar decreases for samples with at least three AMR genes (46·8% vs 27·6%; 0·44 [0·36-0·55]). 6 years after the introduction of PCV13 in Mongolia, the prevalence of vaccine-type carriage and AMR genes showed a reduction among young hospitalised children with pneumonia. Reductions in vaccine-type carriage are likely to result in reductions in pneumococcal pneumonia. GAVI, the Vaccine Alliance.

Abstract 4136294: Carbohydrate intakes and cardiovascular disease risk factors in South Asians: Results from 56,024 participants in Bangladesh, India, Pakistan, and Sri Lanka

Background: Evidence on effects of carbohydrate intake with cardiovascular disease risk factors is inconsistent and has limited generalizability to diverse populations such as South Asians, whose carbohydrate intakes are typically high. Aims: We examined the association of the quantity and types of carbohydrate intake with two risk factors for major cardiovascular events– hypertension (HT) and hypercholesterolemia (HC). Methods: We analyzed cross-sectional data from participants aged ≥18 years in the South Asia Biobank in Bangladesh, India, Pakistan, and Sri Lanka. Using dietary data assessed with interviewer-led 24h diet recalls, we calculated intakes of total and subtypes of carbohydrates and several indices of carbohydrate quality. Primary outcomes were HT and HC, defined by medication use, doctor diagnosis, blood pressure and blood lipid levels. With mixed effects Poisson regression, HT and HC was regressed on quantiles of carbohydrate intakes by country to estimate prevalence ratios (PR) and 95% confidence intervals (CI), followed by meta-analysis pooling country-specific estimates. We examined interactions by diabetes status and adiposity. Results: Of 56,024 adults, 36.6% had HT, 16.1% had HC. In pooled multivariable analyses comparing extreme quantiles, total carbohydrate intake was not associated with HT or HC prevalence. Fructose, free sugar and free sugar-to-fiber ratio were associated with higher prevalence of HT (PRs Q5vsQ1 : 1.03-1.15). Higher intakes of cereal fiber (PR Q4vsQ1 : 0.96, 95% CI: 0.95-0.98) and legume fiber (PR Q4vsQ1 : 0.98, 95% CI: 0.97-0.98) were associated with lower prevalence of HT and higher cereal fiber intake with lower HC prevalence (PR Q5vsQ1 : 0.80, 95% CI: 0.75-0.85). Diabetes and adiposity were observed as effect-modifiers (p&lt;0.001). There were null associations in adults with diabetes but in non-diabetic adults, free sugar intake was related positively with HT (PR Q5vsQ1 : 1.07, 95% CI: 1.05-1.09) while fiber intake was inversely related (PR Q5vsQ1 : 0.98, 0.95-0.97). Starch, sugar and free sugar intake were associated positively with HT prevalence in adults with high body fat (≥20% for men; ≥30% for women) and visceral fat (≥10%) levels (PRs Q5vsQ1 : 1.03-1.20); associations were null for low body and visceral fat levels. Associations varied by country (between-country heterogeneity I 2 &gt;60%). Conclusion: Associations of dietary carbohydrates with HT and HC depended on the quality and type of intake in South Asians.

Neighborhood social cohesion and sleep health among sexual minoritized US adults and intersections with sex/gender, race/ethnicity, and age

ObjectivesNeighborhood social cohesion or living in communities characterized by trust and social ties may mitigate sleep disparities among sexual minoritized vs. heterosexual persons; but its relation to sleep health is understudied among sexual minoritized groups. To investigate associations between perceived neighborhood social cohesion and sleep health among adult US men and women who identified as “lesbian or gay, bisexual, or something else,” we used cross-sectional National Health Interview Survey data (2013-2018). MethodsParticipants reported neighborhood social cohesion (categorized as low or medium vs. high) and sleep characteristics. Adjusting for sociodemographic, health, and residential characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals for poor sleep. ResultsAmong 4666 sexual minoritized adults, 44% reported low, 32% medium, and 24% high neighborhood social cohesion. Women, minoritized racial/ethnic groups, and young adults disproportionately reported low neighborhood social cohesion. Overall, low vs. high neighborhood social cohesion was associated with a higher prevalence of short sleep (PR=1.27 [95% confidence interval:1.11-1.45]) and all sleep disturbances (e.g., PRinsomnia symptoms=1.36 [1.19-1.55]). PRs were often higher as intersectionality or membership to multiple minoritized groups increased. ConclusionsLower perceived neighborhood social cohesion was associated with poorer sleep. Fostering community cohesiveness may mitigate sleep disparities among sexual minoritized adults.

Frailty in patients with ovarian cancer and the role of healthcare access, race, and ethnicity

ObjectiveOvarian cancer has poor 5-year survival, particularly among non-Hispanic (NH) Black patients. Efforts to identify patients at high-risk of functional limitations and frailty may improve outcomes. In this study, we examined how healthcare access (HCA) and race/ethnicity relate to frailty among patients with ovarian cancer. MethodsWe identified Hispanic, NH Black, and NH White patients diagnosed at ages ≥6 5 years with ovarian cancer between 2009 and 2015 using SEER-Medicare. Log-binomial regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the association between HCA and race/ethnicity with pre- or post-diagnosis frailty, adjusting for age and comorbidities. ResultsA total of 6041 patients with ovarian cancer were included, including 91.8% NH White, 6.6% NH Black, and 1.7% Hispanic. Pre-diagnosis, 14.7% of patients were defined as frail (NH White: 14.3%; NH Black: 17.9%; Hispanic: 20.8%). Post-diagnosis, frailty prevalence increased to 58.8% (NH White: 58.2%; NH Black: 65.2%; Hispanic: 70.2%). No statistically significant associations were observed between race/ethnicity and pre- or post-diagnosis frailty in fully adjusted models. After adjustment for patient characteristics and healthcare accessibility and availability, higher healthcare affordability was associated with a decreased prevalence of pre-diagnosis frailty (PR: 0.91, 95% CI: 0.8 5, 0.98). ConclusionsPatients with ovarian cancer have a high prevalence of frailty after diagnosis, particularly NH Black and Hispanic patients. Improving healthcare affordability may prevent or help manage frailty in Medicare patients, improve receipt of cancer treatment, and increase cancer survival.

HIV and Viremia Prevalence in Nonmigrating Members of Migrant Households in Southern Uganda: A Cross-Sectional Population-Based Study.

In Africa, migrants are more likely to be living with HIV and HIV viremic than nonmigrants, but less is known about HIV outcomes among nonmigrants living in households with migrants. We compared HIV outcomes in nonmigrating persons in households with and without migration. We analyzed cross-sectional data collected between August 2016 and May 2018 from nonmigrating participants aged 15-49 years in the Rakai Community Cohort Study in Uganda. Migrant households were classified as those reporting ≥1 member moving into or out of the household since the prior survey. HIV serostatus was determined using a validated testing algorithm, and viremia defined as >1000 copies/mL. Modified Poisson regression was used to estimate prevalence ratios between household migration and HIV outcomes. Analyses were stratified by gender, direction of migration (into/out of household), and relationship between nonmigrants and migrants (eg, spouse). There were 14,599 nonmigrants (52% women) and 4415 (30%) lived in a household with ≥1 migrant. Of these, 972 (22%) had migrant spouses, 1102 (25%) migrant children, and 875 (20%) migrant siblings. Overall, HIV prevalence and viremia did not differ between nonmigrants in households with and without migration. However, in stratified analyses, nonmigrant women with migrant spouses were significantly more likely to be HIV seropositive compared with nonmigrant women with nonmigrant spouses [adjusted prevalence ratio: 1.44, 95% confidence interval: 1.21 to 1.71]. Conversely, nonmigrant mothers living with HIV who had migrant children were less likely to be viremic (adjusted prevalence ratio: 0.34, 95% confidence interval: 0.13 to 0.86). Nonmigrating women with migrating spouses are more likely be living with HIV, and may benefit from additional HIV support services.

Self-reported health effects from wildfire smoke: A cross-sectional study in New York State

Abstract Background Wildfires and exposure to wildfire smoke (WFS) are forecasted to increase, in part driven by climate change. As witnessed in 2023, regions in Europe and North America are facing more sustained periods of poor air quality due to WFS. Growing evidence suggests average daily WFS correlates with morbidity and mortality, but the impact of prolonged WFS exposure remains understudied, especially in areas where WFS is a newer occurrence. We examine associations between consecutive days of WFS experienced and self-reported health symptoms in the northeastern United States. Methods This retrospective cross-sectional study explored New York State (NYS) residents’ experience with WFS in summer 2023 via an online survey. Participants reported the longest period of consecutive WFS days and symptoms experienced. Log-binomial regression models estimated prevalence ratios (PR) and 95% confidence intervals (CI). Results 553 NYS residents were included, representing a healthy, primarily female and White population, ranging from 18 to 86 years. 549 (99.3%) reported experiencing WFS, with the longest period of consecutive WFS days varying (≤3 days: n = 152; 4 to 6 days: n = 255; ≥7 days: n = 146). 490 (88.6%) reported ≥1 health symptom, with itchy/watery eyes, sore throat, and headache as the most frequent. Compared to ≤ 3 consecutive WFS days, symptom prevalence was 9.1% higher for those reporting 4 to 6 days (PR [95% CI]:1.09 [1.00, 1.19]) and 16.7% higher for ≥7 days (1.17 [1.07, 1.27]). The trend of increased symptom prevalence with longer WFS periods persisted and was pronounced for specific symptoms. Control for potential confounders did not appreciably change estimates. Conclusions Our findings suggest longer sustained WFS exposure associates with higher symptom prevalence, which may be precursors to more serious health conditions. As global populations face more WFS with climate change, public health professionals should prioritize strategies to mitigate prolonged exposure. Key messages • In a convenience sample of 553 primarily healthy New York State residents, 99.3% reported experiencing wildfire smoke and 88.6% reported at least 1 symptom of poor health during summer 2023. • Associations between consecutive days of wildfire smoke experienced and prevalence of any and specific symptoms tended to vary in a dose-response manner.

National survey to estimate seroprevalence for toxoplasmosis among pregnant women in France, 2021

Abstract Background Toxoplasmosis during pregnancy can result in congenital malformations and fetal death. In France, universal antenatal screening and monthly re-testing of seronegative pregnant women has been established since the 1970s. However, decreasing Toxoplasma gondii seroprevalence among pregnant women and lower incidence of congenital toxoplasmosis may challenge the cost-effectiveness of such programs. The aim of this study was to estimate the current seroprevalence among pregnant women participating in the 2021 national perinatal survey (ENP). Methods All adult women giving birth in France between 15-21 March 2021 were invited to participate in the ENP. Data collected included demographic information, nationality, socio-economic status, education level and Toxoplasma gondii serology. We classified a woman as seropositive if she had IgG antibodies prior to pregnancy or seroconverted during it. Univariable and multivariable regression analyses using Poisson model were conducted to estimate prevalence ratios (PRs) and identify significant factors associated with seropositivity. Results Among the 15,605 participating women, 0.22% seroconverted during pregnancy. The overall seroprevalence was 25.95%. Seropositivity was higher with increasing age (∼5% per 5 years), among residents of French overseas territories Guadeloupe/Saint Martin (PRs:1.07; 95%-CI: 1.03-1.10), La Réunion (PRs:1.10; 95%-CI: 1.08-1.13) and Mayotte (PRs:1.27; 95%-CI: 1.23-1.31), with lower education (PRs:1.22; 95%-CI: 1.04-1.42) and African nationality (PRs:1.11; 95%-CI: 1.02-1.20). Conclusions High seroprevalence for Toxoplasma gondii was found in older women, which may reflect their higher risk of past exposure. The observed geographical differences in seroprevalence may mirror dietary and environmental diversity. Declining seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies. Key messages • Older women and residents of French overseas territories show higher toxoplasmosis seroprevalence, possibly due to past exposure risks and diverse diets/environments. • Declining toxoplasmosis seroprevalence among pregnant women in France can affect screening effectiveness and warrants a comprehensive review to determine appropriate future prevention strategies.

Social network size and endorsement of political violence in the US

BackgroundIn recent years, the United States (US) has witnessed a rise in political violence. Prior research has found that an individual’s social network is associated with their likelihood of engaging in various forms of violence, but research on social networks and political violence in the US context is limited. This study examined associations between social network size and endorsement of political violence in a recent nationally representative survey and explored how the relationship varied by use of social media as a major news source, perceptions of the government as an enemy, and membership in a marginalized or privileged racial or ethnic group.MethodsThis was a nationally representative cross-sectional survey study of adults aged 18 and older in the US, administered from May 13-June 2, 2022. The exposure was social network size, defined by the number of strong social connections. We examined three violence-related outcomes: support for non-political violence, support for political violence, and personal willingness to engage in political violence. We estimated prevalence ratios for associations using survey-weighted Poisson regression with robust standard errors, adjusting for hypothesized confounders and including interaction terms to examine effect measure modification.ResultsThe sample included 8,620 respondents. Median age was 48.4 years (95% CI = 47.9–48.8), 51.5% were female (95% CI = 50.4–52.7%), and 62.7% self-identified as non-Hispanic White (95% CI = 61.4–65.9%). In adjusted models, those with zero strong connections were more likely than those with 1–4 strong social connections to consider political violence usually/always justified in general (PR = 2.43, 95% CI = 1.47–4.01). Those with 50 + strong connections were more likely than those with 1–4 strong social connections to consider political violence usually/always justified in at least one situation (PR = 1.19, 95% CI = 1.03–1.37) and were more likely to report being willing to personally use political violence (PR = 1.52, 95% CI = 1.13–2.04). Associations varied somewhat by social media use, perceptions of the government as an enemy, and racialized identity.ConclusionsIndividuals who reported very few and very many strong social connections were more likely than others to support political violence or be personally willing to engage in it in one form or another. Findings point toward potential intervention and prevention opportunities.

The Association Between Cognitive Function and Oral Health in Home Dwellers and Nursing Home Residents: The HUNT Study.

To evaluate the relationships of cognitive function and care dependency with oral health in a Norwegian older adult population. This cross-sectional study included 2623 participants aged 70 and older from the fourth wave of the Trøndelag health study (HUNT4 70+) and the city of Trondheim (Trondheim 70+). Neurocognitive disorders (NCDs) were diagnosed by clinical experts according to the DSM-5 framework. Care dependency referred to nursing home residency. Oral health was assessed by using the Revised Oral Assessment Guide-Jönköping (ROAG-J). Individuals were considered as 'having oral problem' if the score was two or three in at least one of the nine ROAG-J items. Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). The prevalence of having oral problems was 19% higher in participants with NCDs than those with normal cognitive function after adjusting for potential confounders (PR 1.19, 95% CI: 1.09-1.29). Further analysis showed a higher prevalence of having oral problems for home dwellers with NCDs (PR 1.23, 95% CI: 1.13-1.33) and nursing home residents (PR 1.32, 95% CI: 1.20-1.45) compared to home dwellers with normal cognitive function. NCDs were associated with an increased prevalence of oral problems in this Norwegian older adult population. The study suggests the need for increasing oral care for home dwellers with NCDs and nursing home residents.

The Prevalence of Sjögren's Disease in Dental Clinics in the Netherlands Compared with the Prevalence in a Systematic Literature Review of Studies in Other Countries.

Background/Objectives: Sjögren's disease (SjD) is an autoimmune disease causing irreversible damage to the exocrine glands but can have symptoms throughout the entire body. The aim of this study is to determine the prevalence of Sjogren's disease (SjD) in the Netherlands, compare this with the prevalence for other countries in a systematic literature review. Methods: In the first part of this study, the prevalence of SjD was determined at two academic dental clinics in the Netherlands by electronically analysing patient records. In the second part of this study, a systematic literature search was performed in PubMed. Studies in the English language reporting prevalence ratios (PRs), incidence ratios (IRs) or sufficient data to calculate these parameters were included. Population-based studies and population surveys aiming to examine an entire geographic region or using a clearly defined sampling procedure were included. Review studies were excluded. Studies that did not report sufficient data or contained no original data were excluded. Included studies were assessed using the Newcastle-Ottawa assessment scale. Results: At the dental clinic in Amsterdam, 76 SJD patients were identified among a patient population of 81941, resulting in a prevalence ratio of 93 per 100,000 (0.093%) patients. In Nijmegen, 21 SjD patients were identified in a total patient population of 14,240, resulting in a prevalence ratio of 147 per 100,000 (0.15%). Thirty-one studies were included in the systematic review. They varied in diagnostic criteria for SjD with the American-European Consensus Group (AECG) criteria being the most widely used. The reported prevalence ratio varied from 0.008% to 3.3%. The overall pooled prevalence ratio of SjD using the AECG criteria was 0.031%, while the pooled prevalence of SjD using the EU criteria was 0.029%. The overall pooled incidence ratio was 5.2 (95%CI 4.7 to 5.6) per 100,000 person-years. Conclusions: The estimated prevalence ratio of SjD in the Netherlands (0.09% to 0.15%) falls within the worldwide range but is higher than the worldwide pooled prevalence ratio.

Fear of Cancer Recurrence in Adult Survivors of Childhood Cancer

Fear of cancer recurrence is common among survivors of adult-onset cancer and associated with increased distress, functional impairment, and health care utilization. However, little is known about the prevalence and risk factors of fear of cancer recurrence among adult survivors of childhood cancer who are also at high risk for subsequent malignant neoplasms. To characterize the prevalence of and risk factors for clinically significant fear of cancer recurrence in adult survivors of childhood cancer. This cross-sectional investigation included participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort study of long-term childhood cancer survivors treated at 31 institutions between 1970 and 1999 across North America. Participants were recruited and completed psychosocial measures via online survey between October 2018 and April 2019. Cancer and treatment-related variables were abstracted from medical records. Data were analyzed from May 2023 to July 2024. Clinically significant fear of cancer recurrence was assessed via the Fear of Cancer Recurrence Inventory-Short Form. Poisson regression models estimated prevalence ratios (PRs) with 95% CIs adjusted for age and sex to examine the associations of demographic, disease, treatment, and psychosocial variables with fear of cancer recurrence. The final sample included 229 adult survivors of childhood cancer (115 female [50.2%]; mean [SD] age, 39.6 [9.9] years; mean [SD] time since diagnosis, 31.7 [8.4] years). Among survivors, 38 (16.6%; 95% CI, 11.6%-21.6%) reported clinically significant fear of cancer recurrence, and an additional 36 (15.7%) reported high fear of cancer recurrence. Clinically significant fear of cancer recurrence was associated with unemployment (PR, 2.5; 95% CI, 1.3-4.8), presence of neurologic chronic health conditions (PR, 3.3; 95% CI, 1.8-6.1), treatment with pelvic radiation (PR, 2.9; 95% CI, 1.5-5.6), and amputation or limb sparing surgery (PR, 2.4; 95% CI, 1.2-4.9). Higher risk of clinically significant fear of cancer recurrence was also associated with having either elevated anxiety or depression (PR, 2.6; 95% CI, 1.2-5.9), having both elevated (PR, 3.2; 95% CI, 1.2-8.4), and perceived poor health status (PR, 3.0; 95% CI, 3.1-9.7). Decades following treatment, one-third of childhood cancer survivors in this study reported elevated fear their cancer will recur or a subsequent malignant neoplasm will develop. Findings suggest that fear of cancer recurrence should be routinely screened, and clinically significant symptoms intervened upon as a part of survivorship care.