Higher Prevalence Ratio Research Articles

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.

SARS-CoV-2 Prevalence in a Delivering Refugee Population: Refugee Status, Payor Type, Race, and Vaccination Status

Underserved communities were disproportionately affected during the coronavirus (COVID-19) pandemic. Limited data exist on the impact of COVID-19 among refugee populations because refugee status is not often classified in electronic medical record (EMR) systems, unlike race or primary language. The study aim was to evaluate the PCR-based prevalence of SARS-CoV-2 in a delivering population over the first 2 years of the pandemic by refugee status, ethnicity, insurance, and vaccination status. A cross-sectional study examined parturient patients admitted to an urban safety-net hospital from May 2020 to May 2022 who were tested for SARS-CoV-2on admission. Percentages and prevalence ratios of SARS-CoV-2 between refugee status, insurance type, vaccination status, and race/ethnicity were calculated across four time periods, corresponding with variant surges of the pandemic. 3,502 patients delivered, 476 (13.6%) were refugees. Self-pay (46.4%) and Medicaid (46.4%) were the most frequent insurance types with a Hispanic predominance (64.5%) by race/ethnicity. Only 12.8% of patients received at least one vaccine before delivery: 13.2% in non-refugees versus 10.3% refugees 192 (5.5%) of the mothers tested positive during the study period with 6.1% refugees positive versus 5.4% among non-refugees, (prevalence ratio, 1.13; P = 0.53, 95% confidence interval [0.77, 1.66]). Positive tests ranged between 4.7% and 6.3% across insurance types and between 4.4% and 7.5% across race/ethnicity categories. The highest prevalence ratio (refugee/non-refugee) of 2.01 was during the Delta Surge (P = 0.12, 95% confidence interval [0.84, 4.82]) and the lowest prevalence ratio of 0.64 was during the Omicron Surge (P = 0.21, 95% CI [0.32, 1.30]). Among refugees when examined by primary language, 51.7% of positive tests were from those speaking languages of the African Great Lakes region (Kinyarwanda, Kirundi, Swahili, Kiswahili). We observed only small differences in SARS-CoV-2 prevalence between refugees and non-refugees or in vaccination status. Variations in prevalence ratio were seen by refugee status by variant surge. Subsets of the refugee population, when grouped by language/region, appeared to be more affected. This warrants future research on the impact of the SARS-CoV-2 pandemic on specific refugee communities, rather than refugee communities as a heterogenous unit.

Diagnostic Errors and their Impact on Obstetric Outcomes among Post-Natal Women at Level Five Teaching and Referral Hospitals in Bungoma County, Kenya

Diagnostic errors are a global problem. Kenya has a high annual maternal mortality prevalence ratio of 362/100,000 live births. Bungoma County has a higher prevalence of diagnostic errors of 382/100,000 live births annually which exceeds the national average. Maternal and neonatal mortality arises from morbidity caused by diagnostic errors in Bungoma County. Thus, this study investigated the relationship between diagnostic errors and obstetric outcomes among post-natal women at level five hospitals in Bungoma County. Swiss Model guided this study. The study used a cross-sectional research design which was hospital-based (Bungoma and Webuye hospitals). Systematic sampling was used to obtain 327 respondents after proportionate allocation to each hospital, and purposive sampling to select 8 healthcare workers as key informants. Data was collected using a structured questionnaire and an interview guide. The pre-test was done with validity established through crosschecking and reliability calculated using the Cronbach method (0.891). Using a statistical package for social sciences version 25, descriptive and inferential statistics were run where chi-square and odds ratio were used to determine the relationship between diagnostic errors and obstetric outcomes. The findings showed that diagnostic errors on average constituted 68.7% at the antenatal care clinics. Individual diagnostic errors were delayed diagnosis (56.9%), missed diagnosis (61.2%), absent diagnosis (72.5%), wrong diagnosis (65.1%), misinterpretation of tests (75.8%) and unnecessary investigation (80.7%). The safe obstetric outcome from the diagnostic errors was 77.4% and the unsafe obstetric outcome was 22.6%. The computed Odds Ratio (OR) indicated that delayed diagnosis (OR=1.661, p < 0.001), missed diagnosis (OR=1.587, p < 0.001), absent diagnosis (OR=1.454, p < 0.001), wrong diagnosis (OR=1.532, p < 0.001), misinterpretation of tests (OR=1.425, p < 0.001) and unnecessary investigation (OR=1.389, p < 0.001) were more likely to result in a safe obstetric outcome especially when matched at the final diagnosis. The matched diagnosis was 5.625 times more likely to result in a safe obstetric outcome as compared to an unmatched diagnosis. In conclusion, diagnostic errors from the matched diagnosis were 5.625 times more likely to prevent adverse obstetric outcomes as compared to diagnostic errors from the unmatched diagnoses. This study recommends that there should be continuous monitoring and evaluation of the antenatal care units to ascertain the diagnosis and history of the pregnant women to cushion against diagnostic errors that may result in adverse obstetric outcomes.

Identification of genetic risk variants for Type-2 Diabetes mellitus in Pakistani Pashtun population: A case-control association study.

Pakistan, a South Asian developing country, is experiencing a rapid increase in number of diabetes cases. High prevalence ratio of diabetes in Pakistani population and lack of genetic research studies prompted us to design this study. This present study investigated Pakistani Pashtun population for (known and novel SNPs) and its possible correlation with Type-2 Diabetes Mellitus (T2DM). This two stage (discovery & validation stage), case-control association study included one thousand individuals (Patients with T2DM=500 & controls=500) from eight districts of Khyber Pakhtunkhwa Pakistan. The study duration/period was from March 2018 to January 2020. In the first stage (the discovery stage) the target population was screened for known and novel T2DM-associated genetic markers. In the validation stage, identified variants were confirmed for T2DM association using MassARRAY genotyping and association analysis. Exome sequencing detected eleven known and four novel/new genetic markers in the study population. Novel variants were preferred over the known for follow-up analysis/validation. Among the identified variants strong associations were confirmed for the following variants; rs1781133/ANKRD65 (OR=2.10, 95%Cl=1.06-3.08, P=0.003) rs2274791/TTLL10 (OR=1.97, 95%Cl=1.36-2.62, P=0.025), rs71628928/RNF223 (OR=1.82, 95%Cl=0.97-1.92, P=0.041), and rs609805/SCNN1D (OR=2.21, 95%Cl=1.92-3.09, P=0.001) with T2DM; other reported variants showed no noticeable association (having P>0.05) with T2DM. This study reports new genetic risk variants for T2DM in Pashtun population providing valuable insights into the genetic basis of T2DM in this group.

Differences in SARS-CoV-2 antibody prevalence at the end of the pre-vaccination period between age groups: A cross-sectional analysis of the multi-ethnic population-based HELIUS study.

During the first waves of the COVID-19 pandemic, SARS-CoV-2 antibody prevalence (seroprevalence) was lower in older compared to younger adults. We studied age group differences in SARS-CoV-2 seroprevalence, across ethnic groups, and assessed the explanatory value of factors that increase the exposure to the virus, and factors related to susceptibility, given the level of exposure. We analysed cross-sectional data from 2,064 participants from the multi-ethnic HELIUS study (Amsterdam, The Netherlands). SARS-CoV-2 seroprevalence at the second wave of infections was compared between age groups (<40, 40-54, and ≥55 years), within ethnic groups, using Poisson regression with robust standard errors. To determine whether age group differences were explained by differences in exposure and in susceptibility, we sequentially adjusted for exposure (job setting, occupation level, health literacy, household size, household member with suspected infection), education level, and susceptibility (vitamin D intake, BMI, systolic blood pressure, haemoglobin level, number of comorbidities). SARS-CoV-2 seroprevalence did not statistically differ across age groups (p>0.05), but age patterns varied across ethnic groups. Age group differences in SARS-CoV-2 seroprevalence were most pronounced in the Dutch majority group, with the highest prevalence ratio in the youngest group (2.55, 95%CI 0.93-6.97) and the lowest in the oldest group (0.53, 95%CI 0.16-1.74), compared to the middle-aged group. In ethnic minority groups, age group differences were smaller. In all groups, patterns did not substantially change after adjustments for exposure and susceptibility variables. We found no evidence of age group differences in SARS-CoV-2 seroprevalence, particularly for ethnic minority groups, even when accounting for exposure and susceptibility. While early prevention strategies particularly aimed at protecting older adults against SARS-CoV-2 infections, seroprevalence was similar across age groups in ethnic minority groups. Thus, older adults in ethnic minority groups may pose a target group for additional prevention strategies for future infectious disease outbreaks.

Overview of Skin Cancer and Risk Factors

Skin cancer is a complex and serious health condition with high metastatic abilities and comprises two types including melanoma, the most dangerous type, and non-melanoma skin cancer, such as basal cell carcinoma and squamous cell carcinoma. Skin cancer has a high prevalence ratio and millions of mortalities worldwide. Multiple risk factors account for the initiation, development, progression, and metastasis of skin cancer such as ultraviolet radiations, X-rays, immunocompromised situations, skin lesions, and alteration in genetic makeup. CEP55, FOXM1b, and HELLS genes play critical roles in the progression of the cell cycle, cell proliferation, cell division, DNA replication, and repair system. The overexpression of these genes involves complex molecular mechanisms and is linked with the development and progression of multiple cancers including skin cancer. This review article summarized the history and recent advancement of risk factors for skin tumorigenesis development and progression.

Association between women’s empowerment and demand for family planning satisfied among Christians and Muslims in multireligious African countries

BackgroundAlthough the levels of demand for family planning satisfied (DFPS) have increased in many countries, cultural norms remain a significant barrier in low- and middle-income countries. In the context of...

The impact of workplace violence on the mental health of health care workers during the COVID-19 pandemic.

The COVID-19 pandemic introduced a new set ofwork-related stressors for health care workers. This study aimed to investigate the associations between exposure to violence and common mental disorders among health care workers in emergency care settings during COVID-19 in the city of São Paulo, Brazil. We randomly selected two emergency care units. The 12-item General Health Questionnaire was used to assess common mental disorders among emergency health care workers (n = 100). We examined the relationships between common mental disorders and COVID-19 pandemic-related variables, including availability of personal protective equipment, exposure to violence, discrimination, harassment, and confidence in the workplace to handle the pandemic. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for common mental disorders. Overall, 50% (95%CI 39.8-60.1) of participants had a common mental disorder. In addition, 71% reported being victims of at least one type of violence during the COVID-19 pandemic. Higher risks ofcommon mental disorders were found among those who reported lacking personal protective equipment, being victims of discrimination, violence, or harassment, and reporting less confidence in the workplace to handle the pandemic. Participants exposed to two types of violence and three types of violence had higher prevalence ratios, with prevalence ratios of 2.28 (95%CI 1.23-4.21) and 3.14 (95%CI 1.62-6.08), respectively. Promoting access to personal protective equipment, addressing mistreatment of health workers as well as promoting their well-being at work, and building confidence in the workplace to deal with the pandemic are critical.

Creating a Modified Version of the Cambridge Multimorbidity Score to Predict Mortality in People Older Than 16 Years: Model Development and Validation.

No single multimorbidity measure is validated for use in NHS (National Health Service) England's General Practice Extraction Service Data for Pandemic Planning and Research (GDPPR), the nationwide primary care data set created for COVID-19 pandemic research. The Cambridge Multimorbidity Score (CMMS) is a validated tool for predicting mortality risk, with 37 conditions defined by Read Codes. The GDPPR uses the more internationally used Systematized Nomenclature of Medicine clinical terms (SNOMED CT). We previously developed a modified version of the CMMS using SNOMED CT, but the number of terms for the GDPPR data set is limited making it impossible to use this version. We aimed to develop and validate a modified version of CMMS using the clinical terms available for the GDPPR. We used pseudonymized data from the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC), which has an extensive SNOMED CT list. From the 37 conditions in the original CMMS model, we selected conditions either with (1) high prevalence ratio (≥85%), calculated as the prevalence in the RSC data set but using the GDPPR set of SNOMED CT codes, divided by the prevalence included in the RSC SNOMED CT codes or (2) conditions with lower prevalence ratios but with high predictive value. The resulting set of conditions was included in Cox proportional hazard models to determine the 1-year mortality risk in a development data set (n=500,000) and construct a new CMMS model, following the methods for the original CMMS study, with variable reduction and parsimony, achieved by backward elimination and the Akaike information stopping criterion. Model validation involved obtaining 1-year mortality estimates for a synchronous data set (n=250,000) and 1-year and 5-year mortality estimates for an asynchronous data set (n=250,000). We compared the performance with that of the original CMMS and the modified CMMS that we previously developed using RSC data. The initial model contained 22 conditions and our final model included 17 conditions. The conditions overlapped with those of the modified CMMS using the more extensive SNOMED CT list. For 1-year mortality, discrimination was high in both the derivation and validation data sets (Harrell C=0.92) and 5-year mortality was slightly lower (Harrell C=0.90). Calibration was reasonable following an adjustment for overfitting. The performance was similar to that of both the original and previous modified CMMS models. The new modified version of the CMMS can be used on the GDPPR, a nationwide primary care data set of 54 million people, to enable adjustment for multimorbidity in predicting mortality in people in real-world vaccine effectiveness, pandemic planning, and other research studies. It requires 17 variables to produce a comparable performance with our previous modification of CMMS to enable it to be used in routine data using SNOMED CT.

Spatial patterns and sociodemographic predictors of chronic obstructive pulmonary disease in Florida.

Chronic obstructive pulmonary disease (COPD) is a chronic, inflammatory respiratory disease that obstructs airflow and decreases lung function and is a leading cause death globally. In the United States (US), the prevalence among adults is 6.2%, but increases with age to 12.8% among those 65 years or older. Florida has one of the largest populations of older adults in the US, accounting for 4.5 million adults 65 years or older. This makes Florida an ideal geographic location for investigating COPD as disease prevalence increases with age. Understanding the geographic disparities in COPD and potential associations between its disparities and environmental factors as well as population characteristics is useful in guiding intervention strategies. Thus, the objectives of this study are to investigate county-level geographic disparities of COPD prevalence in Florida and identify county-level socio-demographic predictors of COPD prevalence. This ecological study was performed in Florida using data obtained from the US Census Bureau, Florida Health CHARTS, and County Health Rankings and Roadmaps. County-level COPD prevalence for 2019 was age-standardized using the direct method and 2020 US population as the standard population. High-prevalence spatial clusters of COPD were identified using Tango's flexible spatial scan statistics. Predictors of county-level COPD prevalence were investigated using multivariable ordinary least squares model built using backwards elimination approach. Multicollinearity of regression coefficients was assessed using variance inflation factor. Shapiro-Wilks, Breusch Pagan, and robust Lagrange Multiplier tests were used to assess for normality, homoskedasticity, and spatial autocorrelation of model residuals, respectively. County-level age-adjusted COPD prevalence ranged from 4.7% (Miami-Dade) to 16.9% (Baker and Bradford) with a median prevalence of 9.6%. A total of 6 high-prevalence clusters with prevalence ratios >1.2 were identified. The primary cluster, which was also the largest geographic cluster that included 13 counties, stretched from Nassau County in north-central Florida to Charlotte County in south-central Florida. However, cluster 2 had the highest prevalence ratio (1.68) and included 10 counties in north-central Florida. Together, the primary cluster and cluster 2 covered most of the counties in north-central Florida. Significant predictors of county-level COPD prevalence were county-level percentage of residents with asthma and the percentage of current smokers. There is evidence of spatial clusters of COPD prevalence in Florida. These patterns are explained, in part, by differences in distribution of some health behaviors (smoking) and co-morbidities (asthma). This information is important for guiding intervention efforts to address the condition, reduce health disparities, and improve population health.

Electronic device and social network use and sleep outcomes among adolescents: the EHDLA study

BackgroundConsidering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.MethodsThis was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.ResultsCell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).ConclusionsOur results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.

Is panoramic radiography reliable to evaluate the relationship between maxillary molar and premolar roots and the maxillary sinus?

Aim: To evaluate the radiographic signs of proximity relationship between maxillary molar roots and maxillary sinus in panoramic radiographs, using CBCT as control. Methods: 81 examinations of patients who had panoramic radiographs and CBCT of the maxillary molars and pre molars region were used. Pathological situations were excluded from this study. Panoramic radiographs and CBCT were evaluated randomly and separately by an experienced dental radiology examiner. 1,055 root apices were evaluated individually. When assessing the relationship between maxillary molar and pre molar apices, and maxillary sinus, the examiner rated the images, both in panoramic radiography and CBCT, according to a scale of 0 to 3, where 0–Without relationship or distant; 1-Root apex projection or overlapping; 2-Maxillary sinus circumventing the tooth root; 3-Interruption of the continuity of maxillary sinus floor. Tabulated data were statistically analyzed using Kappa test and interclass correlation coefficient (ICC) respectively, with a significance level of 5%. A second analysis of the sample was performed after 15 days to analyze reproducibility. Results: Kappa test indicated near perfect reproducibility (Kw=0.973). The highest prevalence ratio, when comparing the classification in panoramic radiographs and CBCT, was for type 1 (52,7%). There was no difference between the type 1 signal and the gold standard observed on CBCT (ρ=0.2152). Conclusion: Panoramic radiography can be used to evaluate the relationship between roots of maxillary molars and premolars with the maxillary sinus. For cases where there is overlapping between apices and maxillary sinus, CBCT remains the indicated exam for better evaluation.

Consumption of alcoholic beverages in Brazil: estimation of prevalence ratios - 2013 and 2019.

To estimate the prevalence of weekly, monthly and abusive alcohol consumption in Brazil in 2013 and 2019, compare the period estimates, and verify the magnitude of the differences. Analysis of data on alcohol consumption in the adult population (18 years or older) from the National Health Survey (PNS), 2013 and 2019. The number of interviewees in 2013 was 60,202 and 88,531 in 2019. The samples were characterized according to demographic, socioeconomic, health, and alcohol consumption variables and differences in proportions in the period were compared using Pearson's c2 test, with Rao-Scott approximation and a 5% significance level. Multivariate Poisson regression models were estimated for the outcome variables of monthly, weekly and abusive consumption of alcoholic beverages, in order to estimate the magnitude of the differences between the 2013 and 2019 PNS estimates, using the prevalence ratio (PR). Models were adjusted per sex and age group and stratified per sex and demographic region. There was a difference in the distribution of the population according to race, occupation, income, age group, marital status, and education. There was an increase in alcohol consumption for all outcome variables, with the exception of weekly consumption in males. The PR of weekly consumption was 1.02 (95%CI 1.014-1.026), and in females the PR was 1.05 (95%CI 1.04-1.06). The highest PRs in the general population and per sex occur for abusive consumption. The increase in weekly consumption per region occurred in the South, Southeast, and Central-West regions. Males are the main alcohol consumers in Brazil; the PRs for both males and females show that there was an increase in monthly, weekly and abusive consumption in the research period; it is noteworthy that females have increased their consumption pattern with greater intensity than males.

Risk Assessment of Type 2 Diabetes Mellitus Using the American Diabetes Association (ADA) Diabetes Risk Test in Residents of Bah Bolon Village, Simalungun District

Background: The prevalence of DM Type 2 is expected to increase to 7079 per 100,000 individuals in 2030 and 7862 in 2040.Meanwhile, based on Riskesdas data, Indonesia has a prevalence of DM of 2.1% in 2013. The highest prevalence was in Deli Serdang (2.9%) and followed by Medan (2.7%), Pematang Siantar (2.2%), Asahan (2.1%), Gunungsitoli (2,1%), Simalungun (1.57%) and Mandailing Natal (0.3%). The ADA Diabetes Risk Test is a simple strategy that used for screening prediabetes and diabetes in asymptomatic adults. Simalungun Regency is one of the 10 districts with a high prevalence of DM after Medan, Pematang Siantar and Asahan.Bah Bolon Village is one of the villages located in Dolog Masagal District.Bah bolon village is a remote village and far from the city and health facilities covering 342 heads of families. Aim of study is to know about how much risk factor of DM type 2 in Simalungun Distric using ADA Diabetes Risk Test. Methods: This study is analytical with a cross-sectional retrospective design.Data were analyzed after distribution test, then mean difference and correlation test was using the SPPS program where p &lt;0.05 was considered statistically significant. Result: This study showed that the prevalence ratio of the ADA Diabetes Risk Test was 3.04 which indicates that there is an increased risk of DM 3 times compared to individuals who have a low risk ADA Diabetes Risk Test score. The highest prevalence ratio is a history of hypertension. A history of hypertension increases the risk of developing T2DM sixfold. A history of hypertension has a 95% CI value of 2.19-17.84 which indicates that people with hypertension have a 2.19 to 17.84 times higher risk of developing T2DM. Conclusions: The significant association DM about 3 times in ADA Diabetes Risk Test between high score and low score, significant association between hypertension history with hyperglycemia. Keywords: DM Type 2, Risk Factors, ADA Diabetes Risk Test, Screening DM

The combined consumption of fresh/minimally processed food and ultra-processed food on food insecurity: COVID Inconfidentes, a population-based survey.

To investigate whether the combined consumption of fresh/minimally processed and ultra-processed food is associated with food insecurity (FI) during the COVID-19 pandemic. Cross-sectional observational study was derived from a survey using a population-based search of a complex sample. FI was assessed using the validated Brazilian Food Insecurity Scale. Food consumption was assessed using a qualitative FFQ and the NOVA classification for fresh/minimally processed food and ultra-processed food. A scoring system was used to evaluate combined food consumption according to the extent and purpose of processing, considering the weekly consumption of the two groups (according to the NOVA classification). Higher punctuation reflects worse diet quality (higher consumption of ultra-processed foods and lower consumption of fresh/minimally processed foods). A theoretical causality model was constructed using a directed acyclic graph, and multivariate analysis was performed using Poisson regression to test the association between FI and food consumption. Ouro Preto and Mariana, Brazil, between October and December 2020. An epidemiological household survey was conducted with 1753 individuals selected through a stratified and clustered sampling design in three stages. Those with food consumption scores in the fourth quartile had a 60 % higher prevalence ratio (PR) for FI (PR: 1·60 and 95 % CI: 1·06 - 2·40). Also, the increased consumption of fresh/minimally processed foods and low consumption of ultra-processed foods presented a 45 % lower prevalence ratio of FI (PR: 0·55 and 95 % CI: 0·40 - 0·80). These results indicate an inverse association between FI and diet quality.

Association Between History of Adverse Pregnancy Outcomes and Coronary Artery Disease Assessed by Coronary Computed Tomography Angiography

Adverse pregnancy outcomes are recognized risk enhancers for cardiovascular disease, but the prevalence of subclinical coronary atherosclerosis after these conditions is unknown. To assess associations between history of adverse pregnancy outcomes and coronary artery disease assessed by coronary computed tomography angiography screening. Cross-sectional study of a population-based cohort of women in Sweden (n = 10 528) with 1 or more deliveries in 1973 or later, ascertained via the Swedish National Medical Birth Register, who subsequently participated in the Swedish Cardiopulmonary Bioimage Study at age 50 to 65 (median, 57.3) years in 2013-2018. Delivery data were prospectively collected. Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, preterm delivery, small-for-gestational-age infant, and gestational diabetes. The reference category included women with no history of these exposures. Coronary computed tomography angiography indexes, including any coronary atherosclerosis, significant stenosis, noncalcified plaque, segment involvement score of 4 or greater, and coronary artery calcium score greater than 100. A median 29.6 (IQR, 25.0-34.9) years after first registered delivery, 18.9% of women had a history of adverse pregnancy outcomes, with specific pregnancy histories ranging from 1.4% (gestational diabetes) to 9.5% (preterm delivery). The prevalence of any coronary atherosclerosis in women with a history of any adverse pregnancy outcome was 32.1% (95% CI, 30.0%-34.2%), which was significantly higher (prevalence difference, 3.8% [95% CI, 1.6%-6.1%]; prevalence ratio, 1.14 [95% CI, 1.06-1.22]) compared with reference women. History of gestational hypertension and preeclampsia were both significantly associated with higher and similar prevalence of all outcome indexes. For preeclampsia, the highest prevalence difference was observed for any coronary atherosclerosis (prevalence difference, 8.0% [95% CI, 3.7%-12.3%]; prevalence ratio, 1.28 [95% CI, 1.14-1.45]), and the highest prevalence ratio was observed for significant stenosis (prevalence difference, 3.1% [95% CI, 1.1%-5.1%]; prevalence ratio, 2.46 [95% CI, 1.65-3.67]). In adjusted models, odds ratios for preeclampsia ranged from 1.31 (95% CI, 1.07-1.61) for any coronary atherosclerosis to 2.21 (95% CI, 1.42-3.44) for significant stenosis. Similar associations were observed for history of preeclampsia or gestational hypertension among women with low predicted cardiovascular risk. Among Swedish women undergoing coronary computed tomography angiography screening, there was a statistically significant association between history of adverse pregnancy outcomes and image-identified coronary artery disease, including among women estimated to be at low cardiovascular disease risk. Further research is needed to understand the clinical importance of these associations.

Sleep duration and periodontal health in older adults: an analysis of the Health, Aging, and Body Composition Study

Objective: To analyze the association between sleep duration and periodontal parameters in older adults. Materials and Methods: Data from 1,136 community-resident older adults participating in the Health, Aging, and Body Composition (Health ABC) Study were used. Hours of sleep per night were determined by self-report. Probing pocket depth (PPD) and clinical attachment level (CAL) were evaluated for all teeth present. Periodontal disease was categorized, considering different cut-points of PPD (at least one site with ≥4mm, ≥5mm, or ≥6mm) and CAL (≥3mm in &gt;20%, &gt;30%, or &gt;40% of the sites). Multivariate Poisson regression with robust variance was used to estimate the association of PPD and CAL with sleep duration (&gt;5h/day, &gt;6h/day, and &gt;7h/day). Analyses were adjusted by sociodemographic, behavioral, medical history, and oral health factors. Results: No association was observed between sleep duration and any level of PPD. However, older adults who sleep &gt;7h/day presented a 15% higher prevalence ratio (PR) of presenting CAL ≥3mm in ≥30% of the sites (95% confidence interval [CI]: 1.02–1.29). A similar trend was observed for CAL ≥3mm in ≥40% sites and sleep duration of &gt;7h/day, but did not achieve statistical significance (PR: 1.17; 95% CI: 0.99–1.36). Conclusion: Sleep duration was not consistently associated with periodontal parameters in older adults.

Accelerometer-derived physical activity and sedentary behaviors in individuals with newly diagnosed type 2 diabetes: A cross-sectional study from the Danish nationwide DD2 cohort.

Habitual physical activity behaviors of individuals with new-onset type 2 diabetes are largely unknown. We aimed to investigate accelerometer-derived physical activity behaviors in individuals with newly diagnosed type 2 diabetes. We also examined sociodemographic and health-related correlates of a high-risk physical activity profile. This cross-sectional study used data from 768 participants enrolled in an intervention study nested within the Danish Centre for Strategic Research in Type 2 diabetes (DD2) cohort. Physical activity was assessed by 24-h dual monitor accelerometry. Prevalence ratios of having a high-risk physical activity profile were estimated using Poisson regression adjusted for age and sex. Study participants spent on average 9.7 (25th and 75th percentiles, 8.3; 11.1) hours/day sitting, walked for 1.1 (0.8; 1.6) hours/day and accumulated 4,000 (2,521; 5,864) steps/day. Still, 62% met the recommendations for physical activity. Characteristics associated with a high-risk physical activity profile (observed in 24.5% of participants) included older age, higher body mass index (BMI), unemployment, retirement, comorbidities, and current smoking. Hence, participants aged 60-69, 70-79 and 80+ years had prevalence ratios of 2.12 (95% CI 1.31; 3.42), 1.99 (1.18; 3.34) and 3.09 (1.42; 6.75) for a high-risk activity profile, respectively, versus participants <50 years. BMI values of 30-39 and 40+ were associated with 1.83 (1.06; 3.15) and 3.38 (1.88; 6.05) higher prevalence ratios compared to normal-weight. Unemployment or retirement was associated with 1.62 (1.09; 2.41) and 2.15 (1.37; 3.39) times higher prevalence ratios, compared to individuals in the working force. Having a Charlson Comorbidity Index score of 1-2 or 3+ was associated with 1.36 (1.03-1.79) and 1.90 (1.27-1.84) higher prevalence ratios, while current smoking was associated with a prevalence ratio of 1.72 (1.25; 2.35) compared to never smokers. This study shows that 62% of individuals with newly diagnosed type 2 diabetes met the recommendations for physical activity. Still, the majority of participants were also highly sedentary and accumulated very few daily steps, emphasizing the need for focusing on both increasing physical activity and reducing sedentary behaviors in the prevention of diabetes-related complications. Individuals with a high-risk physical activity profile were characterized by more obesity, socioeconomic inequalities, advanced age and comorbidities.Trial registration number: NCT02015130.

Sexualized drug use among men who have sex with men in Madrid and Barcelona: The gateway to new drug use?

This original study compares the prevalences of drug use for any purpose and for sexualized drug use (SDU) among MSM. It also describes relevant characteristics of first SDU, analyzes to what extent SDU has been the first experience (the gateway) with different drugs by age and explores the correlates of SDU. Study participants included 2,919 HIV-negative MSM attending four HIV/STI diagnosis services in Madrid and Barcelona. They answered an online, self-administered questionnaire. Poisson regression models with robust variance were used. About 81.4% had ever used any drug, and 71.9% had done so in the last-12-months, while 56% had ever engaged in SDU, and 50% had done so in the last-12-months. Participants under 25 years old had the lowest prevalences of SDU, and the 25-39 age group the highest, except for Viagra, which was higher among those over age 40. The most frequently used drugs for first SDU were poppers (53.6%), cannabis (19.6%) and Viagra (12.2%). These drugs were also the most ever consumed for SDU. Among sexualized users, methamphetamine (78.3%) and Mephedrone (75.4%) were used always/most of the times for sex in the last-12-months. Around 72.2% of Mephedrone sexualized users and 69.6% of Methamphetamine vs 23.1% of ecstasy users' first consumption of these drugs involved use for sex. These drugs were provided to them free where they have sex for 66.8, 79.1, and 31.9%, respectively. On that occasion, 8.1% of Mephedrone, 6.8% of Methamphetamine and 18.4% of ecstasy users had sex only with steady partner; with 50.2, 56.2, and 26.2% respectively using a condom with any partner. SDU in the first use was associated with similar variables for recreational and chemsex drugs. The highest prevalence ratios were for having ever been penetrated by >20 men and having ever injected drugs. It can be concluded that the prevalence of SDU was more than half of the prevalence for any purpose. Thus SDU was the gateway to use for many drugs in an important proportion of users, who frequently consumed drugs that were free and had condomless anal sex with occasional and multiple partners. These circumstances were much more common for chemsex than for recreational drugs.

Sleep duration and its association with cardiometabolic outcomes among adolescents enrolled in the SI Program in Spain

Abstract Background Sleep duration has been inversely associated with increased prevalence of overweight/obesity in childhood and adolescence [1, 2]. However, large studies linking over time objectively measured sleep duration and other cardiometabolic outcomes in adolescence are lacking. Purpose To evaluate sleep duration and its association with cardiometabolic outcomes in a large cohort of adolescents aged 12 to 16 years from the SI! Program for Secondary Schools trial in Spain [3], together with its relationship with sociodemographic variables. Methods Seven-day actigraphic recording was performed in 1229 adolescents at baseline (49.7% girls; 12.5 (0.4) years), 1058 at first follow-up (51.1% girls; 13.9 (0.4) years), and 895 at second follow-up (52.3% girls; 15.8 (0.4) years). Three groups were defined: very short sleep duration (&amp;lt;7 h), short sleep duration (7 to 8 h), and reference sleep duration (≥8 h) [4]. Overweight/obesity were determined according to BMI age- and sex-adjusted percentiles. Continuous Metabolic Syndrome (MetS) score was calculated as the sum of the age-and-gender specific z-scores of mean arterial pressure (MAP) (MAP = ((systolic BP − diastolic BP)/3) + diastolic BP), waist circumference, and fasting blood measures of high-density lipoprotein cholesterol (HDL-c) levels multiplied by −1, triglycerides, and glucose levels [5]. Associations between sleep duration and cardiometabolic outcomes were analyzed using generalized linear and Poisson distribution adjusted models. Results At 12 years of age, only 34.2% of the adolescents met sleep recommendations (sleep hours ≥8), and this percentage decreased with advancing age (23.4% and 19.4% at approximately 14 and 16 years of age, respectively) (Figure 1). Boys and individuals from migrant families tended to sleep shorter. Moreover, sleep duration was directly associated with sleep quality and efficiency. After adjusting for potential cofounders, very short sleepers (&amp;lt;7h) had a higher prevalence ratio (PR) of overweight/obesity at baseline (PR: 1.21 [95% CI: 1.16 to 1.27]) and at first follow-up (PR: 1.72 [95% CI: 1.08 to 2.74]) than the reference group (≥8 h) (Figure 2). Similarly, very short sleepers showed higher mean MetS scores at baseline (0.98 [95% CI: 0.43 to 1.54] and at first follow-up (0.76 [95% CI: 0.24 to 1.27]) as compared with the reference group. Short sleepers showed similar trends with associations of weaker magnitude, as they were the overall associations between sleep duration and cardiometabolic outcomes at second follow-up. Conclusions Most adolescents, and particularly those with a migrant background, did not meet sleep recommendations. Moreover, a shorter sleep duration was associated with cardiometabolic outcomes, particularly at 12 and 14 years of age and when sleeping less than 7 hours. Health promotion programs should emphasize the importance of good sleep habits. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): 1. Fundaciό la Maratό de TV3.2. SHE Foundation and “la Caixa” Foundation.