Low Prevalence Research Articles

Microbiota composition of Culex perexiguus mosquitoes during the West Nile virus outbreak in southern Spain

West Nile virus (WNV) is a flavivirus naturally circulating between mosquito vectors and birds, occasionally infecting horses and humans and causing epidemiologically relevant outbreaks. In Spain, the first big WNV outbreak was recorded in 2020, resulting in 77 people infected and 8 fatalities, most of them in southern Spain. Culex perexiguus was identified as the primary vector of WNV maintaining its enzootic circulation of the virus. Growing evidence highlights the role of mosquito microbiota as a key component determining the vectorial capacity of mosquitoes, largely contributing to disease epidemiology. Here, we develop, to our knowledge, the first identification of the microbiota composition of this mosquito vector under natural conditions and test for the potential relationship between mosquito microbiota composition and WNV infection. To do so, we collected mosquitoes in a natural area of southern Spain during the 2020 WNV outbreak and identified the microbiota composition of mosquitoes using a 16S rRNA gene metabarcoding approach. The microbiota of Cx. perexiguus was dominated by the phylum Proteobacteria. The most abundant families were Burkholderiaceae and Erwiniaceae, including the genera Burkholderia, Erwinia, and Pantoea. The genus Wolbachia, which use to dominate the microbiota of Cx. pipiens and negatively interact with WNV according to the literature, had a low prevalence and relative abundance in Cx. perexiguus and its abundance did not differ between WNV-positive and WNV-negative mosquito pools. The microbiota diversity and composition of Cx. perexiguus were not significantly related to the WNV infection status. These results provide the first identification of the mosquito microbiota in an endemic area of WNV circulation in Spain.

Prenatal Exercise Decreases Urinary Incontinence in Late Pregnancy and Three Months Postpartum: A Randomized Controlled Trial

ABSTRACT Purpose This study aimed to evaluate the impact of a supervised exercise program, including Pelvic Floor Muscle Training (PFMT), throughout pregnancy on Urinary Incontinence (UI). Methods A randomized clinical trial (NCT04563065) was conducted. Initially, 600 pregnant women were screened for eligibility, with data from 356 participants eventually analyzed. Of these, 172 were allocated to the Exercise Group (EG) and 184 to the Control Group (CG). Participants in the EG engaged in a supervised moderate exercise program three days per week, each session lasting 60 minutes, from 8-10 weeks to 38-40 weeks of gestation, achieving an adherence rate of 73.5%. Results A lower prevalence of UI in the EG compared to the CG was observed during late pregnancy (χ2 = 20.04; p = 0.001) and at three months postpartum (χ2 = 12.52; p = 0.03), as well as in birth weight (F = 4.16; p = 0.04). No significant differences were found between the groups in other maternal and newborn outcomes. Conclusions Supervised exercise during pregnancy, which included PFMT, effectively reduced the incidence of urinary incontinence in late pregnancy and at three months postpartum.

Occurrence and assemblage distribution of Giardia Duodenalis in symptomatic and asymptomatic patients in southeastern Iran (2019-2022).

The ubiquitous protozoan parasite Giardia duodenalis is a major contributor to the global burden of diarrhoea, particularly in young children living in poor-resource regions. Although rarely mortal, giardiasis is associated with growth retardation and cognitive impairment in early childhood. Here we investigate the epidemiology of human giardiasis in Iranshahr (south-eastern Iran), a region where this information was previously lacking. Stool samples were collected from 17,455 outpatients and inpatients attended at three major hospital settings during April 2020 and March 2022. Microscopy was used as a screening method for the presence of Giardia cysts, and the identification of G. duodenalis assemblages was carried out using PCR and Sanger sequencing. The overall prevalence of giardiasis was 1.87 (326/17,455; 95% CI: 1.7-2.1). Being female was positively associated with higher odds of giardiasis (p = 0.014). Individuals without diarrhoea were less likely to have giardiasis (p = 0.022). Individuals attending the Iran Hospital were more likely to harbour G. duodenalis infections compared to those attending at the Khatam Hospital and the Clinical Reference Laboratory (p = 0.001). Our sequence analyses revealed the presence of assemblages A (56.5%, 13/23), B (39.1%, 9/23), and A + B (4.4%, 1/23). No association was observed between the occurrence of a given assemblage and the occurrence of diarhroea. Giardia infections were found at relatively low prevalence rates in both symptomatic and asymptomatic individuals seeking medical attention. Being female, having diarrhoea, and being sampled during 2020-21 were predictors of giardiasis. Although limited, our molecular data indicate that some Giardia infections may be zoonotic in nature. These data should be corroborated and expanded in future epidemiological studies targeting simultaneously human, animal, and environmental (water) samples to improve our understanding of the epidemiology of giardiasis in Iran.

Overlap syndrome of hereditary hemorrhagic telangiectasia and juvenile polyposis syndrome: ten years follow-up-case series and review of literature.

Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal vascular dysplasia characterized by the presence of mucocutaneous telangiectasia and arteriovenous malformations in solid organs. The Curaçao criteria and/or detection of ALK1, ENG, and SMAD4 gene mutations are used for diagnosis. Juvenile Polyposis Syndrome (JPS) is diagnosed according to the number and localization of juvenile polyps, and family history of JPS. Both entities have a low prevalence. Mutation of SMAD4 leads to a combined syndrome of these two conditions called HHT-JPS Overlap Syndrome. We aim to describe the clinical characteristics associated with this condition focusing on long term follow up and review of the literature. A cross-sectional descriptive study of HHT-JPS cases from an HHT Institutional Registry was designed. Patients were eligible for this case series if they fulfilled both HHT and JPS diagnostic criteria and/or mutation on SMAD4. A comprehensive review was conducted on the clinical phenotype associated with HHT and its gastrointestinal involvement. Fourteen patients from eleven families in 788 previously HHT-diagnosed patients met the inclusion criteria. The ages ranged between 25 and 70 years old and 12 were females. In addition to the typical signs/symptoms of HHT, two distinct phenotypes were observed. Nine patients predominantly exhibited initially upper, while five showed predominantly initially lower gastrointestinal involvement. Numerous musculoskeletal and cardiovascular anomalies were also identified. The observed phenotypic diversity, particularly in gastrointestinal involvement, underscores the need for tailored clinical approaches. Comprehensive assessments identified associated musculoskeletal and cardiovascular anomalies, emphasizing the systemic nature of HHT-JPS.

Associations between self-compassion and moral injury among healthcare workers: A cross-sectional study.

Healthcare workers (HCWs) can face situations that conflict with their moral beliefs, leading to moral injury, an adverse psychological consequence that was more frequent during the COVID-19 pandemic. Self-compassion is a potential coping mechanism for moral injury by encouraging acceptance of human limitations and suffering. This study aimed to examine the associations between self-compassion components and moral injury prevalence among HCWs in Quebec, Canada, during the COVID-19 pandemic. A cross-sectional study design was employed. Participants: and research context: The sample of this study consisted of HCWs and leaders from the Quebec province. Participants completed validated self-administered questionnaires assessing both positive and negative self-compassion components (self-kindness vs self-judgment; common humanity vs isolation; and mindfulness vs overidentification) and moral injury dimensions (self-oriented and other-oriented). Prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between self-compassion components and moral injury dimensions were modeled using Poison robust regressions. The models were adjusted for various covariates, including sex, age, gender, and socio-demographic and lifestyle factors. Ethical approval for this study was obtained from the ethics committee of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale in Quebec, Canada. All participants provided written informed consent prior to participating in the study. Additionally, permission was sought and obtained from the original authors of the tools used in this study, including the self-compassion and moral injury scales. The study involved 572 HCWs (60.5% nurses) and leaders. Around half of the participants (50.70%) exhibited moderate levels of self-compassion, while the prevalence of low levels of self-compassion ranged from 21.68% to 48.08% for the positive subscales and from 23.78% to 44.41% for the negative subscales. Regarding moral injury, 10.14% of participants reported moderate to high self-oriented moral injury, 29.19% reported moderate to high other-oriented moral injury, and 13.81% demonstrated moderate to high total moral injury. Higher self-compassion levels were associated with lower moral injury prevalence. HCWs with high self-compassion had a 93% lower likelihood of experiencing moral injury (PR: 0.07, 95% CI: 0.03-0.19). Self-kindness demonstrated the strongest association with reduced moral injury (PR: 0.24, 95% CI: 0.11-0.52), followed by mindfulness (PR: 0.37, 95% CI: 0.18-0.75). However, common humanity did not show a statistically significant association with moral injury prevalence. These findings suggest a potential association between self-compassion and reduced prevalence of moral injury among HCWs, highlighting promising interventions to manage moral injury during crises. Such initiatives could promote the mental wellbeing of HCWs and preventing the negative consequences of moral injury, including anxiety, depression, and burnout.

Seasonal variation in dietary intake and its association with obesity-related chronic diseases in northeast China

Abstract Objective The objective of this study was to assess seasonal changes in dietary and nutrient intake of residents (18-75 years old) in Northeast China during summer and winter, and to explore the associations between fatty acids, phytosterols, and the prevalence of obesity-related chronic diseases, particularly obesity, hyperlipidemia, and NAFLD. Methods A total of 4773 participants from the Internet-based Dietary Questionnaire for Chinese (IDQC) were included in this study. Dietary intake information was collected using a validated food frequency questionnaire. Student’s t-test or Mann-Whitney U-test was used to analyze continuous variables, while Chi-squared tests were used to compare categorical variables. Multivariable logistic regression was employed to assess the relationship between fatty acids, phytosterols, and obesity-related chronic diseases. Results The mean consumption of legumes, vegetables, fruits, nuts, dairy products, fish, condiments, energy, protein, fat, and carbohydrate differed significantly between summer and winter (P < 0.05). Significant inverse associations were found between both fatty acids and phytosterols and obesity-related chronic diseases in multivariate adjusted models. Summer polyunsaturated fatty acid (PUFA) intake was negatively associated with the prevalence of hyperlipidemia (Q4, OR, 0.515; 95%CI, 0.283-0.921; P < 0.05) and non-alcoholic fatty liver disease (NAFLD) (Q4, OR, 0.331; 95%CI, 0.176-0.599; P < 0.001). Phytosterols intake was negatively associated with the prevalence of obesity (Q4, OR, 0.603; 95%CI, 0.414-0.873; P < 0.05), hyperlipidemia (Q4, OR, 0.420; 95%CI, 0.233-0.731; P < 0.001), and NAFLD (Q4, OR, 0.206; 95%CI, 0.111-0.360; P < 0.001) during the summer. Conclusions Higher PUFA intake was associated with a lower prevalence of obesity, hyperlipidemia, and NAFLD. Phytosterol intake was inversely associated with the prevalence of hyperlipidemia and NAFLD. These findings suggest that the associations between PUFA and phytosterols and the prevalence of obesity-related chronic diseases may be influenced by seasonal differences in food intake.

Biomedical research grant resubmission: rates and factors related to success – a scoping review

ObjectivesMost first-time biomedical research grant applications are not funded. In the challenging research funding climate, resubmitting a grant application is a necessary task for scientists. Identifying which factors influence their...

Disease assessment in 'coral gardening' nurseries in the Maldives and implications for coral restoration success.

Coral diseases are an increasing threat to continuously degrading reefs as disease abundance and virulence are expected to increase in the future. Active conservation measures, specifically coral restoration projects, are increasingly being implemented worldwide. Yet little is known about the implications of disease occurrence in a restoration context. This study describes white syndrome pathogenesis in 2 coral genera, farmed in 2 mid-water rope nurseries located in a reef and a lagoon habitat in the Maldives. Over a 112 d monitoring period, disease metrics were obtained from 336 Pocillopora and 96 Acropora fragments to assess the impacts of unmitigated disease progression in coral nurseries. Disease had low prevalence (2.2%) and incidence (0.007) in reef-farmed Pocillopora, but survival (91%) was significantly reduced in comparison with the unaffected lagoon-farmed Pocillopora (99%). In contrast, lagoon-farmed Acropora showed high disease prevalence (78.5%) and incidence (0.064), and a lower survival (79%) than disease-unaffected reef-farmed Acropora (98%). These findings had distinct implications for coral gardening success. While Pocillopora was considered suitable for outplanting, especially since subsequent mitigation interventions were successful, the diseased, lagoon-reared Acropora posed a potential risk to the restoration site and was unsuitable for outplanting following 1 yr of farming effort. Our findings demonstrate that unmitigated diseases can cause major setbacks to restoration success. Coral gardening projects are likely to be particularly susceptible; therefore, disease monitoring and risk management are imperative. Since there is currently a lack of available diagnostic and mitigative tools, this study aims to provide case study data for restoration practitioners.

Pediatric Rash Illness Outbreak with Initial Positive Measles Immunoglobulin M Antibody Test Results - American Samoa, March-July 2023.

On April 24, 2023, the American Samoa Department of Health (ASDoH) declared a public health emergency amid concern about a possible measles outbreak given low 2-dose vaccination coverage at the time. ASDoH had received two positive measles immunoglobulin (Ig) M test results after Flag Day festivities 1 week earlier from vaccinated children. ASDoH performed active case finding, took actions to mitigate transmission, and requested technical assistance from CDC. ASDoH implemented a vaccination campaign to improve suboptimal coverage. Confirmatory molecular testing of specimens from these initial persons under investigation (PUIs) was not possible, but subsequent testing of specimens from additional PUIs by Hawaii State Laboratories Division and CDC ruled out measles. In settings with low measles prevalence, measles antibody testing results have low positive predictive value and can lead to difficulties with interpreting results. Testing for additional pathogens revealed a variety of viruses known to cause common childhood viral exanthems. Both molecular and serologic testing should be performed for all suspected measles cases. To decrease the probability of false-positive IgM results, testing should be reserved for cases that meet the Council of State and Territorial Epidemiologists measles case definition, especially those in persons with no evidence of immunity and with a history of recent international travel. In addition, maintaining high measles vaccination coverage can prevent future outbreaks.

Detecting Perkinsus-like organisms and Perkinsus marinus (Myzozoa: Perkinsidae) within new bivalve hosts in the southeastern Gulf of California.

Perkinsus marinus, a parasite myzozoa native from the Atlantic Ocean, has spread across various bivalve species in the Pacific Ocean. In the Gulf of California, clams like Larkinia grandis and Leukoma grata have become a secondary fishery, experiencing demand. During annual sampling (August 2017 - July 2018, n = 30/month), the Ray's fluid thioglycollate medium (RFTM) revealed presumptive hypnospores of Perkinsus sp. in L. grandis, with a low parasite prevalence (4.16%) and density (≤ 3.14 hypnospores g-1 tissue). From summer 2020 to summer 2021, P. marinus was seasonally identified in L. grata via staining and PCR tests, showing mean prevalence and density of 48.33% and 48 hypnospores g-1 tissue, respectively. The infection level was light in both clams. This parasite's presence in these new hosts within the southeastern Gulf of California confirms its ability to expand into non-native places, signaling a need for intervention strategies in managing and transporting mollusk species within the region.

Intra-articular corticosteroid injections versus platelet-rich plasma as a treatment for cervical facetogenic pain: a randomized clinical trial

ObjectiveThe study’s primary objective was to compare the effectiveness of intra-articular platelet-rich plasma injections versus corticosteroid injections for the treatment of cervical facetogenic pain. Secondary aims were to compare self-rated...

Sex-ratio distortion in a weed biological control agent, Ceratapion basicorne (Coleoptera: Brentidae), associated with a species of Rickettsia.

Many endosymbionts of insects have been shown to manipulate and alter their hosts' reproduction with implications for agriculture, disease transmission, and ecological systems. Less studied are the microbiota of classical biological control agents and the implications of inadvertent endosymbionts in laboratory colonies for field establishment and effects on target pests or nontarget organisms. While native-range field populations of agents may have a low incidence of vertically transmitted endosymbionts, quarantine and laboratory rearing of inbred populations may increase this low prevalence to fixation in relatively few generations. Fixation of detrimental endosymbionts in founding biological control agent populations prior to release may have far-reaching effects. Significant female-biased sex-ratio distortion was found within laboratory populations of the weevil Ceratapion basicorne (Illiger), a classical biological control agent that was recently approved for use against yellow starthistle (Centaurea solstitialis L.). This sex-ratio distortion was observed to be vertically inherited and reversible through antibiotic treatment of the host insect. Molecular diagnostics identified a Rickettsia sp. as the only bacterial endosymbiont present in breeding lines with distorted sex ratios and implicated this as the first reported Rickettsia associated with sex-ratio distortion within the superfamily Curculionoidea.

Porcine ear necrosis in nursery piglets is preceded by oral manipulations of the ear.

Porcine ear necrosis (PEN) is characterized by dry crusts on the ear tip. The crusts often progress to moist and bloody lesions and may lead to partial loss of the ear tissue. The cause and pathophysiology of PEN are unknown. Skin infections, systemic infections, or ear biting have been suggested as a cause of PEN, but no proper evidence has been shown. The behavioural factor has not yet been investigated, therefore this study evaluated the importance of oral manipulations in the occurrence of PEN in nursery pigs. Three farms affected by PEN were visited weekly, and the prevalence and severity were recorded. Video recordings of the animals were performed, and the behaviour was evaluated. The presence of pathogens in the lesions and histological alterations were also analysed. The highest percentage of pigs with PEN lesions in the farms ranged between 58 and 93%, with most lesions being of mild to moderate severity. The first ear lesions occurred about 1-2weeks after an increase in the number of ear manipulations in the pens. The frequency of the ear manipulations clearly changed over time, and the number of oral ear manipulation behaviour significantly differed (P < 0.05) between pigs in pens with high and low PEN prevalence. Increased ear manipulation behaviour was significantly related to a subsequent increase in PEN lesions (OR = 4.3; P < 0.001). Metagenomic investigation of lesion scrapings revealed a variety of pathogens mostly with low abundance, where microscopic alterations were found mainly in the epidermis. Oral manipulation of the ear pinnae by pen mates was followed by the development of PEN lesions one to two weeks later. This suggests that the behaviour played an important role in the PEN lesions formation in the nursery pigs of the three farms. Bacteria found in PEN lesions most probably were secondary to initial external skin damage, but their relevance needs to be investigated further.

Self-reported lifetime Hepatitis B virus testing, and vaccination uptake among people who inject drugs in Iran: a nationwide study in 2020.

Hepatitis B virus (HBV) infection is a silent epidemic among people who inject drugs (PWID). HBV testing and vaccination are important for PWID to reduce the risk of infection, prevent chronic complications and contribute to public health efforts in addressing HBV transmission. Our objective was to assess the self-reported lifetime uptake of HBV testing and vaccination among PWID in Iran and their associated factors. This cross-sectional study was conducted among 2,684 PWID in 11 large cities from July 2019 to March 2020 using a respondent-driven sampling method. Participants were interviewed face-to-face and asked about their lifetime experience of HBV testing and vaccination uptake as the outcome. Logistic regression models were built to identify related factors for reporting HBV testing and vaccination uptake. The prevalence of HBV testing and vaccination uptake among PWID was 14.2% (95% confidence intervals [CI]: 12.8-15.6) and 16.4% (95% CI: 14.9-18.1), respectively. Shared needles, syringes, or equipment in the past 12 months decreased the odds of reporting lifetime HBV testing uptake (Adjusted odds ratio [AOR]:0.46, 95% CI: 0.29-0.72). However, having an academic education (AOR: 1.89, 95% CI: 1.09-3.30) and lifetime experience of homelessness (AOR: 1.58, 95% CI: 1.21-2.06) increased the odds of reporting lifetime HBV vaccination uptake. Our study highlighted the low prevalence of HBV testing and vaccination uptake among PWID in Iran. It is essential to understand and address the obstacles preventing PWID from getting tested and vaccinated for HBV. Addressing these barriers could significantly reduce the burden of HBV among this socio-economically marginalized population.

Polygenic Risk Scores and Extreme Coronary Artery Calcium Phenotypes (CAC=0 and CAC≥1000) in Adults ≥75 Years Old: The ARIC Study.

Coronary artery calcium (CAC) is heterogeneous in older age and is incompletely explained by traditional atherosclerotic cardiovascular disease risk factors. The extremes of subclinical atherosclerosis burden are strongly associated with either a low or high 10-year risk of incident atherosclerotic cardiovascular disease, respectively. However, the genetic underpinnings of differences in arterial aging remain unclear. We sought to determine the independent association of 2 polygenic scores for coronary heart disease (CHD) with CAC in adults ≥75 years of age. There were 1865 ARIC (Atherosclerosis Risk in Communities) participants who underwent genetic testing at visit 1 (1987-1989) and CAC scans at visit 7 (2018-2019). In the primary analysis, an externally derived multi-ancestry polygenic CHD risk score was calculated for both White and Black participants. Results were confirmed using a separate ARIC-derived polygenic CHD risk score, including ≥6 million variants computed for White participants. We used multivariable logistic regression models to assess the association of polygenic CHD risk with CAC, after adjusting for baseline, time-averaged lifestyle, traditional risk factors, and local ancestry principal components. In the primary analysis, the average age was 80.6 years old, 61.6% were women, and the median CAC score was 246 (189 participants with CAC=0, 364 participants with CAC≥1000). Compared with persons below the 20th percentile of polygenic CHD risk, persons with polygenic-CHD risk above the 80th percentile had 82% lower odds of having CAC=0 (odds ratio, 0.18 [95% CI, 0.09-0.37]) and had >4-fold higher odds of CAC≥1000 (odds ratio, 4.77 [95% CI, 2.88-7.88]). On a continuous scale, each SD increment increase in the polygenic risk score was associated with a 78% higher CAC score. Results were nearly identical using a second confirmatory polygenic CHD risk score in White participants. Polygenic CHD risk is robustly associated with a lower prevalence of CAC=0 and a higher prevalence of CAC≥1000 in adults ≥75 years of age, beyond lifestyle and traditional risk factors. These results suggest a heritable contribution to distinct healthy and unhealthy arterial aging phenotypes that persist throughout the life course.

Association of life's essential 8 with chronic obstructive pulmonary disease: a population-based analysis of NHANES 2007-2018.

Chronic obstructive pulmonary disease (COPD) is closely linked to cardiovascular diseases. We aimed to investigate the association between Life's Essential 8 (LE8), the newly established measurement to assess cardiovascular health (CVH), and COPD among U.S. general adults. This study extracted the National Health and Nutrition Examination Survey (2007-2018) data. Multivariate logistic regression models were used to examine the associations between LE8 and COPD. A restricted cubic spline regression model was used to explore the dose-response relationships between LE8 scores and COPD. In addition, subgroup and sensitivity analyses were performed to assess the robustness of our results. Our study included 19,774 participants representing 145.2million non-institutionalized U.S. population aged ≥ 20 years. The overall age-adjusted prevalence of COPD was 4.5%. After adjusting for the potential covariates, LE8 was inversely associated with COPD [adjusted odds ratio (AOR) = 0.169, 95% CI: 0.115, 0.249], exhibiting a nonlinear dose-response relationship (P for nonlinearity < 0.05). Similar trends in the associations of health behavior score (AOR = 0.300, 95% CI: 0.223, 0.404) and health factor score (AOR = 0.603, 95% CI: 0.426, 0.852) with COPD were also identified. Furthermore, higher LE8 metric scores of nicotine exposure and sleep health were associated with a lower prevalence of COPD. LE8 was inversely associated with spirometric/self-reported COPD in a nonlinear trend, primarily driven by the nicotine exposure metric of LE8. Adhering to LE8 guidelines, especially smoking cessation, to sustain optimal CVH levels may be beneficial to alleviate the burden of COPD.

Academic Physician and Trainee Occupational Well-Being by Sexual and Gender Minority Status.

Few studies have explored the association between sexual and gender minority (SGM) status and occupational well-being among health care workers. To assess the prevalence of burnout, professional fulfillment, intent to leave, anxiety, and depression by self-reported SGM status. This cross-sectional survey study collected data from October 2019 to July 2021, from 8 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. The survey, including questions on SGM status, was administered to attending physicians and trainees. Statistical analyses were performed from June 1, 2023, to February 29, 2024. SGM status was determined via self-reported sexual orientation and gender identity. Primary outcomes measured were the Professional Fulfillment Index (burnout and professional fulfillment), intent to leave, and self-reported anxiety and depression using the Patient-Reported Outcomes Measurement Information System short-form 4-item measure. Of 20 541 attendings and 6900 trainees, 8376 attendings and 2564 trainees responded and provided SGM status. Of these respondents, 386 attendings (4.6%) and 212 trainees (8.3%) identified as SGM. Compared with their non-SGM peers, SGM attendings had a lower prevalence of professional fulfillment (133 of 386 [34.5%] vs 3200 of 7922 [40.4%]) and a higher prevalence of burnout (181 of 382 [47.4%] vs 2791 of 7883 [35.4%]) and intent to leave (125 of 376 [33.2%] vs 2433 of 7873 [30.9%]) (all P < .001). Compared with their non-SGM peers, SGM trainees had a lower prevalence of professional fulfillment (63 of 211 [29.9%] vs 833 of 2333 [35.7%]) and a higher prevalence of burnout (108 of 211 [51.2%] vs 954 of 2332 [40.9%]) (both P < .001). After adjusting for age and race and ethnicity, SGM attendings had higher odds of burnout than their non-SGM peers (adjusted odds ratio, 1.57 [95% CI, 1.27-1.94]; P < .001). Results for burnout were similar among the SGM trainees compared with their non-SGM peers (adjusted odds ratio, 1.47 [1.10-1.96]; P = .01). In this cross-sectional survey study of academic physicians and trainees, SGM attendings and trainees had higher levels of burnout and lower levels of professional fulfillment. SGM attendings had greater intent to leave than their non-SGM peers, but trainees did not. These disparities represent an opportunity for further exploration to retain SGM health care workers.

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.

Abstract 4122780: Muscle Quality Defines Sarcopenic Obesity in Older Adults In Association with Cardiac Function

Background: Obesity phenotypes are increasingly used to define cardiovascular diseases (CVD) risks. Age-related deteriorations in skeletal muscle function have ignited interest in the co-occurrence of sarcopenia and obesity in older adults. However, the traditional definition of sarcopenia (low appendicular skeletal mass [ASM] and handgrip strength [HGS]) may lead to underdiagnosis of sarcopenic obesity (SO) in overweight individuals (due to higher muscle mass). To address this enigma, we evaluated the use of muscle quality (MQ), as an alternative metric for SO, in association with cardiac function. Methods: Community older adults without CVD were prospectively annotated for skeletal mass, HGS and cardiac function via bioimpedance analysis, dynamometer, and simultaneous acquisition of echocardiography respectively. Sarcopenia was defined by low ASM and low HGS. Low MQ (HGS divided by upper body ASM) was defined by males&lt;5.76kg/kg and females&lt;5.475kg/kg. Aerobic capacity (VO2 max,ml/kg/min) was computed by a physical activity prediction model. Mitral early diastolic inflow velocity to early diastolic annular tissue velocity (E/e’) and early to late diastolic inflow velocity (E/A) ratios were recorded. Results: Overall, low MQ was prevalent (34.3%) in n=574 participants (59% females), but only 17.4% fulfilled sarcopenia diagnosis. Higher BMI correlated with higher ASM but lower MQ (Fig 1). Low MQ prevalence was higher in the obese compared to the non-obese (64.7% vs 30.2%, p&lt;0.0001). Low MQ group was significantly older (69.0±10.4 vs 64.8±14.0 years, p&lt;0.0001), had higher prevalence of dyslipidemia (49.2% vs 40.9% p=0.002) and hypertension (45.2% vs 39.3% p&lt;0.0001) than the normal MQ group. The low MQ group had greater left ventricular mass (129±45 vs 114±44, grams, p&lt;0.0001), left atrial volumes (37±14 vs 33±13, ml, p=0.001), and demonstrated a greater degree of diastolic dysfunction (lower E/A (0.89±0.28 vs 1.1±0.49, p&lt;0.0001 and higher E/e’(8.63±2.42 vs 8.00±2.58, p=0.005), compared to the high MQ. VO2 max was lower in low MQ group (33±5.7 vs 36±6.7, p&lt;0.0001). By regression, low MQ was associated with E/A (β=-0.119, adjusted p&lt;0.0001) and VO2 max (β=-0.137, p&lt;0.0001) (Table 1). Conclusion: Muscle quality is a useful metric of muscle function for sarcopenia in obese older adults. The associations between low MQ with diastolic dysfunction and reduced aerobic capacity corroborate the clinical impact of MQ as a defining metric of sarcopenia in obesity.

Screen time and obesity prevalence in adolescents: an isotemporal substitution analysis.

We examined the associations between screen time and adolescent obesity and the associations of reallocating screen time to other activities using isotemporal substitution models. Understanding the association between screen time and obesity may provide additional insights into effective obesity prevention strategies in adolescents. We conducted a cross-sectional analysis of 5,180 adolescents (4th and 7th grade students) from the Korean Children and Youth Panel Survey 2018. Participants reported their height, weight, and average time spent watching television, using computer, using smartphone, and other after-school activities. Obesity was defined as BMI-for-age and -sex ≥ 95th percentile based on the 2017 Korean National Growth Charts. We performed multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between screen time and obesity prevalence, adjusting for potential confounders. Prolonged smartphone use (≥ 180 vs. <60m/d: OR [95% CI] = 2.75 [2.06, 3.68]) was associated with a higher obesity prevalence. Television watching (≥ 120 vs. <60min/d) was positively associated with obesity prevalence among 4th grade students (2.09 [1.51, 2.89]) but the association was not observed among 7th grade students (0.97 [0.63, 1.49]). One-hour increments of any non-screen time activities, with a simultaneous 1-hour decrease in combined screen time, were associated with a lower obesity prevalence (physical activity: 0.75 [0.65, 0.85]; sleeping: 0.69 [0.62, 0.78]; hanging out with friends: 0.80 [0.71, 0.89]; reading: 0.82 [0.69, 0.97]; studying: 0.84 [0.78, 0.90]; chatting with parents: 0.89 [0.88, 0.98]). Our data suggest that public health strategies that reduce screen time and increase time for non-screen time activities, such as physical activity, may be effective in lowering adolescent obesity prevalence.