High-risk Population Groups Research Articles

Non-adherence to antiretroviral treatment among migrating fishermen in western Kenya’s islands: a rapid qualitative study

Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. The association of migration with HIV and AIDS in sub-Saharan Africa is well documented. Frequent mobility, high consumption of alcohol, multiple sexual partners, transactional and commercial sex, poor health infrastructure and limited access to health services are reported among the main factors shaping the HIV epidemic in fishing communities. Moreover, studies have been conducted in sub-Saharan Africa on adherence to antiretroviral treatment (ART) among fishers; however, non-adherence to ART remains poorly understood among migrating fishermen in the western Kenya islands. This qualitative study investigated factors contributing to non-adherence among fishermen in the western Kenya islands. This study utilised 51 in-depth interviews and six focus group discussions to highlight factors contributing to non-adherence to ART by mobile fishermen. Data were analysed using a contextualised thematic analysis. Results show that migration, alcohol consumption and ART sharing contributed to non-adherence. Adherence to ART is a powerful predictor of survival for individuals living with HIV and AIDS. The Kenyan government can use lessons from this study to target fishermen to achieve the UNAIDS 2025 recommendations on people-centred and context-specific service responses to AIDS as this would move Kenya closer to the 90% reduction in annual infections by 2030. This article contributes to a deeper understanding of how and why fishermen from the islands in western Kenya struggle to adhere to treatment even though they can access ARTs through the public health care system. Longitudinal studies should be conducted to explore how the factors associated with non-adherence correlate with other key health outcomes such as drug resistance.

Catching Cancer Early: The Importance of Dermato-Oncology Screening.

The European Society for Medical Oncology experts have identified the main components of the long-term management of oncological patients. These include early diagnosis through population screening and periodic control of already diagnosed patients to identify relapses, recurrences, and other associated neoplasms. There are no generally accepted international guidelines for the long-term monitoring of patients with skin neoplasms (nonmelanoma skin cancer, malignant melanoma, precancerous-high-risk skin lesions). Still, depending on the experience of the attending physician and based on the data from the literature, one can establish monitoring intervals to supervise these high-risk population groups, educate the patient and monitor the general population.

Deep Clinical Phenotyping of Schizophrenia Spectrum Disorders Using Data-Driven Methods: Marching towards Precision Psychiatry.

Heterogeneity is the main challenge in the traditional classification of mental disorders, including schizophrenia spectrum disorders (SSD). This can be partly attributed to the absence of objective diagnostic criteria and the multidimensional nature of symptoms and their associated factors. This article provides an overview of findings from the Genetic Risk and Outcome of Psychosis (GROUP) cohort study on the deep clinical phenotyping of schizophrenia spectrum disorders targeting positive and negative symptoms, cognitive impairments and psychosocial functioning. Three to four latent subtypes of positive and negative symptoms were identified in patients, siblings and controls, whereas four to six latent cognitive subtypes were identified. Five latent subtypes of psychosocial function-multidimensional social inclusion and premorbid adjustment-were also identified in patients. We discovered that the identified subtypes had mixed profiles and exhibited stable, deteriorating, relapsing and ameliorating longitudinal courses over time. Baseline positive and negative symptoms, premorbid adjustment, psychotic-like experiences, health-related quality of life and PRSSCZ were found to be the strong predictors of the identified subtypes. Our findings are comprehensive, novel and of clinical interest for precisely identifying high-risk population groups, patients with good or poor disease prognosis and the selection of optimal intervention, ultimately fostering precision psychiatry by tackling diagnostic and treatment selection challenges pertaining to heterogeneity.

0394 Effect of electrical vestibular nerve stimulation on sleep quality in young adults with insomnia: a randomized controlled trial

Abstract Introduction Insomnia is a common sleep disorder among all age groups which adversely affects physical and mental health. Young adults are considered a high-risk population group due to increased use of electronic media at bedtime, stress associated with balancing educational demands and unhealthy sleep practices. Previous research suggests that electrical vestibular nerve stimulation (VeNS) may improve sleep outcomes by influencing the hypothalamus and brainstem nuclei involved in regulating the circadian rhythm and wakefulness. The present study is a randomised, double blinded, sham-controlled trial with the aim of assessing the efficacy of VeNS on the sleep quality of young adults suffering from insomnia. Methods Eighty adults aged 18-24 years who scored 15 or higher on the Insomnia Severity Index (ISI) were recruited. Participants assigned to the intervention group (n=40) received 30 minutes per day of VeNS with 5 sessions per week for 4 weeks, while the control group (n=40) received sham stimulation for the same period. ISI scores were recorded at baseline and repeated weekly. The primary outcome was between-group change in ISI from baseline to day 28. Secondary outcomes included between-group change in the emotional states of depression, anxiety and stress measured by the DASS-21 questionnaire, and quality of life (QoL) measured by the WHOQoL-BREF. Results A group-by-time interaction effect on change in ISI score from day 0 to day 28 (F3, 248 = 295.56; P< 0.001) was observed. The intervention group had a higher reduction in mean ISI score relative to the control group at day 28 (mean change [95% CI]: 7.23 [6.78, 7.67] vs. 0.98 [0.89, 1.06], P< 0.001; respectively). Furthermore, the intervention group showed improvements in depression, anxiety, and stress scores (P< 0.001) and QoL outcomes (P< 0.001) compared with the control group. Conclusion Regular VeNS usage over 4 weeks lead to a clinically meaningful decrease in ISI scores and improved general well-being in young adults with insomnia. VeNS may have potential as a drug-free and non-invasive therapy to improve sleep outcomes. Support (if any)

Study neonate’s complications in COVID-19 infected pregnant women in early period of pandemic in Ardabil province, Iran

Background: Pregnant women and neonates are considered as high-risk groups of population. Due to higher risk of COVID-19 in pregnant women, the aim of this study was to determine neonates' complications in COVID-19 infected pregnant women in early period of pandemic in Ardabil province. Methods: This prospective cross-sectional study was conducted on 21 infected pregnant women and their neonates from Feb to June 2020 in Alavi Hospital, Ardabil. Mother’s clinical and laboratory findings and their neonates were registered in a checklist. Neonates’ complications were assessed and infants 'growth and developmental disorders followed up at 28 days, 6 months, and 12 months. Collected data were analysed by statistical methods in SPSS version 24. Results: In terms of clinical symptoms, the most prevalence symptoms were shortness of breath, fever, chills and dry cough. 15 infected mothers had a cesarean section and there was no maternal and neonatal mortality in this study. Of the 21 neonates, 13 were boys and 8 girls. Five neonates had respiratory distress and were admitted to the intensive care unit for 1 week. In these 5 neonates, arterial pH was low and neonatal CRP was high and the blood culture was negative for them. Also, all neonates were negative for COVID-19. None of the newborns had problems with feeding and poor reflexes and other symptoms. All newborns had negative PCR. 19 neonates were born over 2500 grams. Conclusions: Results showed that suffering to COVID-19 had not relation with growth disorder in neonates and mother's clinical symptoms had not different with other symptoms. So we can use similar investigations to control of COVID-19 in all pregnant women. Also, COVID-19 infection in newborns was not associated with growth and developmental disorders in 1 year fallow up.

A nested Benders decomposition-based algorithm to solve the three-stage stochastic optimisation problem modeling population-based breast cancer screening

Population-based cancer screening programmes invite high-risk population groups to screenings in order to increase the probability of an early diagnosis. In this paper, we study the organisation of preventive breast cancer screening, accounting for both scheduling of patients and planning of resources. Mammography screening comprises a two-stage healthcare process, encompassing a patient scan in a mammography unit and a scan examination by a central coordination center. Objectives are to minimise patient flow times and maximise resource efficiency and number of patients treated. Performance of population-based screening programmes is hampered due to large rates of patient no-shows, which is partially remedied by giving patients the option to cancel or reschedule their appointment. We model the scheduling problem as a three-stage stochastic optimisation problem and propose a diving heuristic relying on Sample Average Approximation and nested Benders decomposition to find high-quality integer solutions. Computational experimentation is performed on real-life instances to benchmark the proposed method to alternative methodologies. Results demonstrate that the proposed heuristic yields a stable performance for instances of different sizes. However, integrating the three decision stages increases significantly the complexity, such that larger-sized instances are preferably solved via two separate solution stages to improve resource efficiency. In addition, insights are provided in the value of stochastic optimisation and strategies to cancel or reschedule appointments mitigating the impact of no-show uncertainty.

A correlation study of cervical cytology on pap smear with cervical biopsy in a tertiary care hospital (1 Year Study)

Introduction: Cervical cancer is the second most common cancer in women worldwide after breast cancer, and in developing countries, the leading cause of death by cancer. It is one of the most preventable and curable of all cancers. The Pap smear is the standard screening tool used to test for the presence of abnormal cells that could become cancerous. A regular Pap smear provides an opportunity to detect pre-cancerous cells in the cervix. The simplicity, effectiveness and versatility of Pap test have made it an integral part of routine clinical examination and large chunk of workload in gynaecological and pathological practice is due to this test. Aims and Objectives: To establish usefulness of pap smears examination as a diagnostic tool for detection of cervical lesions. Material and Method: In present study results of 400 PAP smears are analysed, which had been examined in cytology section (Department Of Pathology, M.P. Shah Medical College, Jamnagar) during 1 years (July 2021 to July 2022). Out of 400 pap smear 250 patients were undergone cervical biopsy or hysterectomy. So the final sample size is 250. The conventional cervical smears were fixed by 100% methanol and stained by Pap method (RAPID-PAP). The cytological smears were reported using Bethesda System 2001. The cervical biopsies or hysterectomy specimens received from the same patients were fixed in 10% neutral buffered formalin solution and processed with embedding in paraffin blocks and stained with haematoxylin and eosin (H and E) stain. The histopathological findings and Pap smear findings were correlated and histopathological diagnosis of biopsies were taken as the gold standard. Result: In present study most common complain was irregular menstrual bleeding followed by lower abdominal pain. Out of 250 pap smears maximum patient belong to 41-50 years and were multipara. Maximum cases were reported as NILM (60%), followed by ASCUS (15.2%), LSIL (12%), HSIL (8%), squamous cell carcinoma (4.8%). On histopathology, 47.6% cases were diagnosed as chronic cervicitis, 23.2% cases as chronic cervicitis with squamous metaplasia, CIN I (17.2%), CIN II (4.4%), CIN III (2.8%), squamous cell carcinoma (4.8%). Overall sensitivity, specificity, positive predictive value and negative predictive value is 95.8%, 83%, 70%, 98% respectively. Conclusion: Pap smear is a simple cheap safe and practical diagnostic tool for early detection of cervical cancer in high risk group population and therefore should be established as a routine screening procedure.

Protected or not? Hepatitis B vaccination status among healthcare workers and the level of protection post-vaccination

BackgroundHepatitis B virus infection is one of the major concerns in global health care. With a far-reaching health, social, economic impact, preventive strategies form the cornerstone of its management. Knowledge about vaccination status and protection rendered thereof would aid in more wholesome management among highrisk population groups like healthcare workers. The aim of this study was to evaluate the Hepatitis B vaccination status among Healthcare workers (HCW) and the level of protection post-vaccination. MethodsDuring the study period a total of 420 HCWs were included in the study. The details of vaccination status was ascertained by an online questionnaire. Serum samples were evaluated for HBsAg status and Anti HBs titres to assess the level of protection against HBV infection. Those who were HBsAg negative, anti-HBc total was assessed. ResultsOur study revealed a high vaccination status among HCWs, n-384 (93.2%). However, the percentage of HCWs who were completely vaccinated was low (56.3%). Most of the study population, n-395 (95.6%) had protective titres of anti-HBs which showed a declining trend with increasing duration since the last dose of the vaccine. ConclusionHepatitis B infection continues to be an important health hazard with significant morbidity and mortality. Healthcare workers are at higher risk of contracting the infection. Merely considering the vaccination status without knowing the protective anti-HBs titres is to be discouraged as it has been observed that the protective antibody titres show a declining trend with time as even completely vaccinated individuals had non-protective levels of antibody titres.

Novel nomograms for predicting the risk of low distal bone strength: development and validation in a Chinese population-based observational study

BackgroundThis study aims to develop nomogram models based on the speed of sound (SOS) measurements results along with demographic information to predict the risk of low bone strength (LBS) of radius appropriate to the Chinese population of a broad age spectrum.MethodsA population-based cross-sectional study was conducted in 5 outpatient clinics located in Zhejiang, the southern part of China. A total of 38,699 participants from 2013 to 2017 were included. Baseline measurements included SOS of the distal radius and clinical risk factor evaluation. Logistic regression models were used to evaluate prognosis and identify independent predictive factors, which were then utilized to establish nomograms for predicting the low bone strength of radius. The discrimination and calibration of nomograms were validated using the calibration plots, the decision curve analysis (DCA), and the receiver operating characteristics curve (ROC).ResultsA total of 19,845 of the 38,904 participants ranged in age from 10 to 88 years were selected in this process. LBP nomogram model 1 was constructed based on age, weight, height, BMI, and gender. LBP nomogram model 2 was constructed based on age, height, BMI, and gender. The AUCs for model 1 and model 2 were 0.838 (95% CI: 0.832–0.844) and 0.837 (95% CI: 0.831–0.843), respectively. High-quality calibration plots and DCA in nomogram models were noticed, indicated that the constructed nomogram models were clinically useful.ConclusionsOur study demonstrates that the nomograms established in this study could effectively evaluate the high-risk population groups of distal radius fracture in China.

Prevalence of COVID-19 Vaccine Hesitancy and Its Associated Factors among Chronic Disease Patients in a Resource Limited Setting in Ethiopia: A Cross-Sectional Study

Background. The COVID-19 pandemic disproportionately affects patients with chronic diseases. Thus, chronic disease patients are among the first high-risk population groups to get vaccinated. This might be challenged by vaccine hesitancy as it is one of the top ten global health issues for 2019. Furthermore, vaccination myths and conspiracy theories have been proliferating, and the developing world can readily embrace them, which might cause vaccine hesitancy. However, there is a paucity of evidence regarding chronic illness patient’s willingness to be vaccinated. As a result, the aim of this study is to determine the magnitude of vaccine hesitancy and associated factors among chronic disease patients in Ethiopia. Method. An institutional-based cross-sectional study was conducted among adult ambulatory chronic disease patients who were selected using stratified sampling technique from June 1 to August 1, 2021. Data were collected through a face-to-face interviewer-administered questionnaire. Vaccine hesitancy was measured based on a questionnaire which was adapted from the reviewed literature. Bivariable and multivariable logistic regression was used to identify factors, and variables with p < 0.05 were considered statistically significant. Result. A total of 422 respondents participated in the survey; the response rate was 99.7%. The mean age of the participants was 45 years ± 16.95 and 228 (54%) of them were male. Almost half of the respondents (49.5%) were hesitant toward the COVID-19 vaccine. Participants who were male (AOR = 1.56, 95% CI: 1.03, 2.35), having good knowledge about the COVID-19 vaccine (AOR = 1.60 95% CI: 1.06, 2.41) and having a comorbidity (AOR = 3.36, 95% CI: 1.73, 6.56), were factors associated with the acceptance of the COVID-19 vaccine. Conclusion. The level of COVID-19 vaccine hesitancy was high. The COVID-19 vaccine’s acceptability was influenced by being a man, having knowledge about the vaccine and having comorbidities. Furthermore, the most prevalent reason for refusing to take the vaccination is a fear that it may not be safe. As a result, public awareness campaigns should concentrate on delivering more information about the COVID-19 vaccine’s safety and efficacy. Furthermore, it is critical to disseminate accurate information, particularly among women, and to educate people about the vaccine.

Construction of a mortality risk prediction model for elderly people at risk of lobectomy for NSCLC.

An increasing number of lung cancer patients are opting for lobectomy for oncological treatment. However, due to the unique organismal condition of elderly patients, their short-term postoperative mortality is significantly higher than that of non-elderly patients. Therefore, there is a need to develop a personalised predictive tool to assess the risk of postoperative mortality in elderly patients. Information on the diagnosis and survival of 35,411 older patients with confirmed lobectomy NSCLC from 2009 to 2019 was screened from the SEER database. The surgical group was divided into a high-risk mortality population group (≤90 days) and a non-high-risk mortality population group using a 90-day criterion. Survival curves were plotted using the Kaplan-Meier method to compare the differences in overall survival (OS) and lung cancer-specific survival (LCSS) between the two groups. The data set was split into modelling and validation groups in a ratio of 7.5:2.5, and model risk predictors of postoperative death in elderly patients with NSCLC were screened using univariate and multifactorial logistic regression. Columnar plots were constructed for model visualisation, and the area under the subject operating characteristic curve (AUC), DCA decision curve and clinical impact curve were used to assess model predictiveness and clinical utility. Multi-factor logistic regression results showed that sex, age, race, histology and grade were independent predictors of the risk of postoperative death in elderly patients with NSCLC. The above factors were imported into R software to construct a line graph model for predicting the risk of postoperative death in elderly patients with NSCLC. The AUCs of the modelling and validation groups were 0.711 and 0.713 respectively, indicating that the model performed well in terms of predictive performance. The DCA decision curve and clinical impact curve showed that the model had a high net clinical benefit and was of clinical application. The construction and validation of a predictive model for death within 90 days of lobectomy in elderly patients with lung cancer will help the clinic to identify high-risk groups and give timely intervention or adjust treatment decisions.

Effect of acute exercise on Cardiovascular and Serum cortisol reactivity to mental stress in offspring of hypertensives

Introduction: The purpose of our study was to evaluate the effect of acute exercise on HR, BP and serum cortisol levels in offspring of hypertensives. This could serve as a preventive measure to habituate the high risk population group right at the early age. Material and Methods: The study was a double blind single centered randomized controlled prospective study conducted in the Department of Physiology & Biochemistry, Maulana Azad Medical College and associated hospitals, New Delhi over a period of 1 year. 30 subjects were recruited for the study. They were labelled as:- Group 1–the subjects were rested for 10 minutes after which the measurement of BP, HR and Serum cortisol was done. This resting value was labeled as R-1. The subjects were then exposed to mental arithmetic test (MAT) for 5 minutes. Thereafter their BP, HR and Serum Cortisol were measured again and labeled as T-1. Group 2–Same subjects were similarly rested for 10 minutes after which the measurement of BP, HR and S. cortisol was done. This resting value was labeled as R-2. This was followed by 20 minutes of Bicycle ergometry exercise. The subjects were then exposed to MAT for 5 minutes. Thereafter their BP, HR and Serum cortisol were measured again and labeled as T-2. We then compared (T2–R2) known as Cardio-Adrenal Reactivity (CAR) with exercise vs CAR without exercise (T1-R1). 2ml of blood sample was withdrawn for estimation S. cortisol. Paired t-test was applied for comparison (p value <0.05–significant). Results: The CAR was more in Group 1 compared to Group 2, difference being statistically significant. Conclusion: Study showed statistically significant change between with and without exercise groups. Acute exercise can reduce the adrenocortical reactivity to stress, a preventive tool for development of future hypertension.

COVID-19 Vaccination Prioritization Strategies in Malaysia: A Retrospective Analysis of Early Evidence

The coronavirus disease 2019 (COVID-19) that can cause extreme acute respiratory syndrome has posed a catastrophic threat to public health. The vaccines had indeed restored optimism and, after more than two years of battling the pandemic, there is renewed hope for the transition to endemicity. At the start of vaccination efforts, when supply shortages of vaccines were inevitable, every nation determined the high-risk population groups to be given priority for the COVID-19 vaccines. In this paper, the characteristics of the initial COVID-19 vaccine recipients in Malaysia are described. In line with the policies of many other countries, Malaysia firstly inoculated frontline healthcare workers, and subsequently the list of front liners grew to include defense and security personnel and those involved in the provision of essential services. People with disabilities or those with special needs and several underlying medical conditions that increased their risk of developing severe COVID-related illnesses were included in the priority categories. These included patients with severe lung disease, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, diabetes mellitus and obesity in adults, splenic dysfunction, and severe mental illness. With little information and under circumstances of great uncertainty, the Health Ministry of a middle-income country had developed a vaccination priority-list based on the disease's epidemiology and clinical data, vaccine type, operational considerations, and risk evaluation. Early evidence was presented and suggested that the full vaccination with any of the three predominant vaccines (AZD1222, BNT162b2, and CoronaVac) in the country had been highly effective in preventing COVID-19 infections, COVID-19-related ICU admissions, and death. As many SARS-CoV-2 variants of concern (VoC), such as the Omicron BA.2/4/5, are emerging, future vaccination strategies may necessitate the need to change the immunogen of the vaccine, as well as considerations for when to give high-risk groups booster injections. These considerations are valuable for future planning by policymakers and healthcare providers to make vaccination policy and decisions, especially for the inclusion of the COVID-19 vaccines into national immunization programs.

Improved indoor air quality during desert dust storms: The impact of the MEDEA exposure-reduction strategies

Desert dust storms (DDS) are natural events that impact not only populations close to the emission sources but also populations many kilometers away. Countries located across the main dust sources, including countries in the Eastern Mediterranean, are highly affected by DDS. In addition, climate change is expanding arid areas exacerbating DDS events. Currently, there are no intervention measures with proven, quantified exposure reduction to desert dust particles. As part of the wider “MEDEA” project, co-funded by LIFE 2016 Programme, we examined the effectiveness of an indoor exposure-reduction intervention (i.e., decrease home ventilation during DDS events and continuous use of air purifier during DDS and non-DDS days) across homes and/or classrooms of schoolchildren with asthma and adults with atrial fibrillation in Cyprus and Crete-Greece. Participants were randomized to a control or intervention groups, including an indoor intervention group with exposure reduction measures and the use of air purifiers. Particle sampling, PM10 and PM2.5, was conducted in participants' homes and/or classrooms, between 2019 and 2022, during DDS-free weeks and during DDS days for as long as the event lasted. In indoor and outdoor PM10 and PM2.5 samples, mass and content in main and trace elements was determined. Indoor PM2.5 and PM10 mass concentrations, adjusting for premise type and dust conditions, were significantly lower in the indoor intervention group compared to the control group (PM2.5-intervention/PM2.5-control = 0.57, 95% CI: 0.47, 0.70; PM10-intervention/PM10-control = 0.59, 95% CI: 0.49, 0.71). In addition, the PM2.5 and PM10 particles of outdoor origin were significantly lower in the intervention vs. the control group (PM2.5 infiltration intervention-to-control ratio: 0.49, 95% CI: 0.42, 0.58; PM10 infiltration intervention-to-control ratio: 0.68, 95% CI: 0.52, 0.89). Our findings suggest that the use of air purifiers alongside decreased ventilation measures is an effective protective measure that reduces significantly indoor exposure to particles during DDS and non-DDS in high-risk population groups.

Hypermetabolic lymphadenopathy following the administration of COVID-19 vaccine and immunotherapy in a lung cancer patient: a case report

BackgroundGiven the current climate of the pandemic, lung cancer patients are especially vulnerable to complications from severe acute respiratory syndrome coronavirus 2 infection. As a high-risk population group, these patients are strongly advised to receive coronavirus disease 2019 vaccination in accordance with Center for Disease Control and Prevention guidelines to minimize morbidity and mortality. In recent years, immunotherapy has taken a preeminent role in the treatment of non-small cell lung cancer with dramatic improvement in overall survival. Reactive lymphadenopathy following the administration of a coronavirus disease 2019 vaccination can confound the radiographic interpretation of positron emission tomography–computed tomography or computed tomography scans from lung cancer patients receiving immunotherapy.Case presentationHere, we present a case of a 61-year-old Caucasian female and former smoker who developed cervical, hilar, supraclavicular, mediastinal, and left retroauricular lymphadenopathy following her coronavirus disease 2019 booster vaccination. At the time, she had been receiving long-term immunotherapy for the treatment of advanced lung adenocarcinoma. Biopsy was pursued owing to concerns of treatment failure and confirmed recurrent malignancy.ConclusionThis case report highlights the importance of lymph node biopsies in lung cancer patients who present with contralateral lymphadenopathy following coronavirus disease 2019 vaccination to rule out tumor recurrence in this deserving patient population.

Disparities in Cigarette, E-cigarette, Cigar, and Smokeless Tobacco Use at the Intersection of Multiple Social Identities in the US Adult Population. Results From the Tobacco Use Supplement to the Current Population Survey 2018-2019 Survey.

Sociodemographic disparities in tobacco use are prevalent and persistent in the United States. Nevertheless, few studies have examined disparities in tobacco use from an intersectionality perspective. We developed a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of multiple social identities. We used the 2018-2019 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) to estimate the prevalence of tobacco product use at the intersection of age (18-34, 35-54, ≥55 years), sex (male, female), race/ethnicity (Non-Hispanic [NH] White, NH Black, Hispanic, NH Other), and annual household income (<$50 000, $50 000-$99 999, and ≥$100 000). Estimates accounted for the complex survey design. For cigarettes, the most defining characteristic was income, with the highest prevalence among low-income NH White male adults aged 35-54 years (30.7%) and low-income NH White female adults aged 35-54 years (29.7%). For e-cigarettes, the most defining characteristic was age, with adults 18-34 years old having the highest prevalence. High prevalence groups for cigars included young- and middle-aged NH Black and NH White males, while NH White males had the highest prevalence of smokeless tobacco use. Our intersectionality visualization tool is helpful to uncover complex patterns of tobacco use, facilitating the identification of high-risk groups. We created a visualization tool to identify disparities in cigarette, e-cigarette, cigar, and smokeless tobacco use at the intersection of age, sex, race/ethnicity, and income. Our visualization tool helps uncover complex patterns of tobacco use, facilitating the identification of high-risk population groups that would otherwise be masked. These results can be used to implement tobacco control policies targeted at factors that promote or sustain tobacco use disparities.

Effectiveness of Second mRNA COVID-19 Booster Vaccine in Immunocompromised Persons and Long-Term Care Facility Residents.

We used a nationwide population registry in South Korea to estimate the effect of a second booster dose of mRNA COVID-19 vaccine on the risk for laboratory-confirmed SARS-CoV-2 infection, critical infection, and death in immunocompromised persons and long-term care facility (LTCF) residents. During February 16-May 7, 2022, among 972,449 eligible persons, 736,439 (75.7%) received a first booster and 236,010 (24.3%) persons received a second booster. Compared with the first booster group, at 30-53 days, the second booster recipients had vaccine effectiveness (VE) against all infections of 22.28% (95% CI 19.35%-25.11%), VE against critical infection of 56.95% (95% CI 29.99%-73.53%), and VE against death of 62.96% (95% CI 34.18%-79.15%). Our findings provide real-world evidence that a second booster dose of mRNA vaccine substantially increases protection against critical infection and death in these high-risk population groups.

TETANUS - A RUSTED NAIL INJURY :REPORT OF A CASE AND REVIEW

Tetanus is rare diagnosis in the post vaccination era ,although it continues to have signicant morbidity and mortality worldwide. High risk population groups carpenters, mechanics, laborer's and soldiers with unknown history of tetanus vaccination. This is a report of a 40 year male, laborer by occupation with an incomplete immunization history who presented to the emergency department with classical triad of trismus, risus sardonicus and opisthotonos and was diagnosed as tetanus. This report highlights the importance of prompt diagnosis, treatment, and prevention of tetanus. It also points out the importance of booster vaccination, as tetanus still remains an important cause of morbidity and mortality in the post vaccination era.

Prevalence of Syphilis Infections Among Volunteer Blood Donors in Jinan Blood Center, China: A 15-Year Retrospective Study.

Syphilis infections among volunteer blood donors increased rapidly in recent years. It is important to analyze the demographics of seropositive donor groups and help to recruit donors from low-risk population. The aim of this study was to analyze the syphilis prevalence among volunteer blood donors in Jinan Blood Center and give direction to blood recruitment. A cross-sectional study was conducted among blood donors in Jinan, China. Socio-demographic data and blood donation testing data from January 2007 to December 2021 were extracted from the database of blood management software of Jinan Blood Center for analysis. All blood samples were screened by ELISA, and those anti-TP-positive samples were counted and analyzed by sex, age, educational background, occupation and blood donation times. Logistic regression was used to explore risk factors associated with syphilis infection. Totally 700,757 blood samples were collected in the study during 2007 to 2021, 2290 cases were detected anti-TP positive with a positive rate of 0.33%. Female, 35-44 years old, with a lower education degree, farmers and first-time donors were the high-risk subgroups. Consultation and identification of high-risk population groups should be improved. Measures should be taken to make the donor recruitment more professional and detailed.

305 PHYSICAL ACTIVITY &amp; DEPRESSION AMONG OLDER ADULTS WITH DIABETES: PRELIMINARY EVIDENCE FROM 10 YEARS OF THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA)

Abstract Background Older adults living with diabetes are at increased risk of physical and mental health issues, including depression. Among older adults living with diabetes, the salutary benefits of Physical Activity (PA), including increased insulin sensitivity and improved glycaemic control, are well established; however, less is known about the relationship between PA and depression. Thus, we quantified associations between different PA doses and depressive symptoms and status among older adults living with diabetes across 10 years (waves 1-5) as part of The Irish Longitudinal Study on Ageing. Methods Older adults (n=268) living with diabetes were identified through self-report and/or medication use. PA was measured with the short-form International Physical Activity Questionnaire. Five dose categories (0, 1-&amp;lt;600, 600-&amp;lt;1,200, 1,200-&amp;lt;2,400 and ≥2,400 MET.minutes per week) were examined. At all waves, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale short form; a score of ≥16 classified depression. From Waves 2-5, the Composite International Diagnostic Interview quantified diagnosis of a Major Depressive Episode during the past 12 months, or depression status. Poisson regression models quantified the associations between PA dose and depressive symptoms and status across time, adjusted for age, health/lifestyle variables, and antidepressant medication. Results The minimal PA dose associated with lower depressive symptoms was 1-&amp;lt;600 MET.mins (coefficient = –0.20; 95%CI: –0.35, –0.05; p≤0.009). A dose of 600-&amp;lt;1200 MET.min was significantly associated with lower odds of depression status (OR = 0.66; 95%CI: 0.50, 0.87; p≤0.004). Additionally, being male, having sufficient vitamin D intake and lower age were associated with lower odds of depressive symptoms. Conclusion Present findings suggest that even low PA doses protect against depressive symptoms among older adults living with diabetes. This further supports the importance of promoting PA for mental health among this high-risk population group.