Prevalence Rate Ratio Research Articles

Oral health-related quality of life of older Australian men.

The aims of this study were to assess oral health-related quality of life (OHRQoL) in a cohort of older Australian men and explore the association between their general health conditions, socio-demographic factors and OHRQoL. The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of Australian men, initiated in 2005-2006 with an initial sample of 1705 men 70 years or over. Participants completed a self-administered health and socio-demographic questionnaire and attended an interview and clinical assessment at baseline and each of three follow-up assessments. Information on oral health and responses to the Oral Health Impact Profile (OHIP-14) were collected in the 4th follow-up in which 778 men completed the OHIP-14 questionnaire and 614 men had a dental assessment. The prevalence of oral health impact was defined as a response of fairly often or very often to one or more of the OHIP-14 questions. Mean OHIP-14 scores were calculated for the 14 questions and used as the dependent variable in the regression analyses. Zero-inflated Poisson regression was used to estimate prevalence rate ratios (PRR). Only 10% of men presented oral health impacts. In multivariate regression modelling, being born in Italy/Greece (PRR: 2.16, 95% CI: 1.93-2.42) or in other countries (PRR: 2.12, 95% CI: 1.89-2.38), having poor self-rated general health (PRR: 1.38, 95% CI: 1.24-1.53), having poor mental wellbeing (PRR: 1.14, 95% CI: 1.04-1.24), having ≥6 depressive symptoms (PRR: 1.18, 95% CI: 1.05-1.32), being a current smoker (PRR: 1.34, 95% CI: 1.06-1.70) and having more decayed tooth surfaces (PRR:1.01, 95% CI: 1.00-1.02) were associated with higher impact scores. Overall, older Australian men exhibit good oral health-related quality of life. The inter-relationship between perceptions of general health and well-being, health and oral health variables and social background supports policy objectives of closer integration of general health and oral health services for older Australian men.

A Cross-Sectional Study on the Relationship between Oral Function and Sarcopenia in Japanese Patients with Regular Dental Maintenance.

We aimed to clarify the relationship between oral function assessments regarding oral hypofunction and sarcopenia in patients who had completed treatment for organic dental problems, including oral pain, removable denture fit, and tooth loss. This cross-sectional study included 269 patients aged ≥65 years (mean age 74.9 ± 6.50 years, 133 men, 136 women) who visited a dental clinic between June 2019 and March 2021. We evaluated oral function and sarcopenia and analyzed their relationship using the Jonckheere–Terpstra test, Mantel–Haenszel trend test, and Poisson regression analysis. We diagnosed 132 (49.07%) patients with oral hypofunction, 30 (11.2%) with sarcopenia, and 24 (8.9%) with severe sarcopenia. The number of oral hypofunction items (prevalence rate ratio [PRR] = 1.39, 95%Wald = 0.11 to 0.56) was significantly associated with sarcopenia. For each of the items, tongue-lip motor function [ta] (PRR = 0.80, 95%Wald = −0.44 to −0.02)] [ka] (PRR = 0.76, 95%Wald = −0.53 to −0.03) and tongue pressure (PRR = 0.95, 95%Wald = −0.09 to −0.02) showed a significant association with sarcopenia. However, no significant association was found for other variables. Dentists should not only treat organic dental problems but also consider the relationship between oral function and sarcopenia.

Overflowing Disparities: Examining the Availability of Litter Bins in New York City.

In the 1980s, activists’ concerns about the disproportionate placements of landfills in low-income communities ignited the environmental justice movement. Today, similar issues of environmental injustice—the limited availability of litter bins across New York City (NYC) neighborhoods—remain unresolved. This study examines the association between NYC neighborhood income and litter bin availability. The NYC Department of Sanitation 2020 Litter Bin Inventory and archival measures of neighborhood composition and socioeconomic status were aggregated within NYC census tract neighborhoods. Multilevel Bayesian conditional autoregressive Poisson models estimated the prevalence rate ratio for counts of litter bins according to median household income in each census tract, accounting for spatial autocorrelation. Bivariate associations identified that census tracts with higher median household income had a greater prevalence of litter bins than census tracts with lower median household income; however, spatial autocorrelation attenuated the relationship between median household income and availability of litter bins. Further research is necessary to identify the spatially structured condition that accounted for the observed effect. The results warrant further investigation of both perceived and actual disparities in litter bin availability.

Gout and Hospital Admission for Ambulatory Care-Sensitive Conditions: Risks and Trajectories.

To investigate the risks and trajectories of hospital admission for ambulatory care-sensitive conditions (ACSCs) in gout. Among individuals aged 35 years to 85 years residing in Skåne, Sweden, in 2005, those with no doctor-diagnosed gout during 1998 to 2005 (n = 576,659) were followed from January 1, 2006, until a hospital admission for an ACSC, death, relocation outside Skåne, or December 31, 2016. Treating a new gout diagnosis (International Classification of Diseases, 10th revision, code M10) as a time-varying exposure, we used Cox proportional and additive hazard models to estimate the effects of gout on hospital admissions for ACSCs. We investigated the trajectory of hospital admissions for ACSCs from 3 years before to 3 years after gout diagnosis using generalized estimating equations and group-based trajectory modeling in an age-and sex-matched cohort study. Gout was associated with a 41% increased rate of hospital admission for ACSCs (hazard ratio 1.41, 95% CI 1.35-1.47), corresponding to 121 (95% CI 104-138) more hospital admissions for ACSCs per 10,000 person-years compared with those without gout. Our trajectory analysis showed that higher rates of hospital admission for ACSCs among persons with gout were observed from 3 years before to 3 years after diagnosis, with the highest prevalence rate ratio (2.22, 95% CI 1.92-2.53) at the 3-month period after diagnosis. We identified 3 classes with distinct trajectories of hospital admissions for ACSCs among patients with gout: almost none (88.5%), low-rising (9.7%), and moderate-sharply rising (1.8%). The Charlson Comorbidity Index was the most important predictor of trajectory class membership. Increased risk of hospital admissions for ACSCs in gout highlights the need for better management of the disease through outpatient care, especially among foreign-born, older patients with comorbidities.

Interaction between serum vitamin C levels and smoking on the periodontal condition in older adults.

Several epidemiological studies have reported that smokers have a higher prevalence and severity of periodontal disease than do nonsmokers, and that smoking negatively affects nutritional status and is associated with a reduced intake of antioxidants, particularly vitamin C. The present investigation aimed to examine the relationship between serum vitamin C levels and smoking and its influence on the periodontal condition in older adults. A total of 353 respondents met the inclusion criteria and were enrolled in the present study. The periodontal status of the study participants was determined through examinations of one or more residual teeth, which included a measurement of the probing pocket depth (PPD) and clinical attachment level (CAL) at six regions of each tooth. Blood samples were collected during the dental examinations and then sent to a laboratory to evaluate serum vitamin C and cotinine levels. A serum cotinine concentration of 100ng/ml was considered a relevant threshold for active smoking. After dividing the participants into two groups according to serum cotinine levels, Poisson regression analysis was carried out to compare vitamin C levels with the prevalence rate ratio (PRR) for periodontal condition markers for each group based on serum cotinine levels. We evaluated differences in the PRR of serum vitamin C tertiles between participants with high (≥100ng/ml) or low (<100ng/ml) serum cotinine levels after adjusting for sex, the use of interdental brushes or dental floss, and the number of teeth. A negative tendency between the PRR of vitamin C tertiles for the PPD or CAL was seen for both groups. Especially, a bigger difference was observed in the group with high serum cotinine levels. The PRR of the first tertiles in the high serum cotinine group was 5.03, compared with 2.69 in the low serum cotinine group (relative risk: 1.9). The results of this study suggest a potential association between vitamin C levels and the periodontal condition, which may be influenced by smoking status.

Gender and tobacco epidemic in South Korea: implications from age-period-cohort analysis and the DPSEEA framework

ObjectivesTo understand a 20-year trend of gender-specific smoking prevalence among adults in South Korea.DesignAge-period-cohort analysis using the intrinsic estimator method was applied to examine the separate contribution of age, period...

Effects of the Targeted Intervention for Five- to Six-Year-Old Children Affected by Attentional and Concentration Developmental Risks: Results of a Dynamic Prospective Cohort Study Conducted in Socially Deprived Regions in Germany

Epidemiological data reveal that there is a need for prevention measures specifically targeted at children with low SES. In the German federal state Mecklenburg-Western Pomerania preschools in socially deprived regions can apply for additional funds to support children with developmental risks. Mandatory criteria for obtaining these funds involve an annual assessment of all children using the “Dortmunder Developmental Screening for Preschools (DESK 3–6 R).” This instrument can detect and monitor developmental risks in the domains fine motor skills, gross motor skills, language, cognition, and social development. In this study, we examine the domain “Attention and concentration,” which is included for the 5 to 6-year-old age group, using data from two consecutive survey waves (sw). Research questions: (1) Does the prevalence rate ratio (PRR) improve over time? (2) Is the rate of improvements (developmental risk at sw1, no developmental risk at sw2) higher than the rate of deteriorations (no developmental risk at sw1, developmental risk at sw2)? Prospective cohort analysis (n = 940). The prevalence rate of a developmental risk in this DESK domain decreases over time (PRR = 0.78; p = 0.019). The ratio of the rate of improvements is 8.47 times higher than the rate of deteriorations. The results provide evidence of the effectiveness of targeted intervention measures in preschools focusing on skills that improve attention and concentration. This is significant considering the small-time interval and the categorization method of DESK scores. Nevertheless, over the same time period, the DESK results of some children deteriorated. Therefore, preschools also have to be aware that it is natural for some children to show modest declines in their skills over time. German Clinical Trials Register, ID: DRKS00015134, Registered on 29 October 2018, retrospectively registered.

Association between bleeding periodontal pockets and eczemas: Results of the Northern Finland Birth Cohort 1966.

To investigate whether the periodontal condition as measured by bleeding periodontal pockets is associated with atopic dermatitis, seborrheic dermatitis, and eczema nummulare. The study population (n=1871) was obtained from the 46-year follow-up study of the Northern Finland Birth Cohort 1966 study (NFBC1966). The periodontal condition was measured by the number of sites with bleeding periodontal pockets that were ≥4 mm deep. The whole skin of the participants was clinically examined, and diagnoses of skin diseases were made according to the International Classification of Diseases. Prevalence rate ratios (PRR) and 95% confidence intervals (95% CIs) were estimated using Poisson regression models with robust error variance. In this cohort, comprising 46-year-old participants of NFBC1966, the presence of 1-3 and ≥4 bleeding-deepened periodontal pockets (≥4 mm deep) were associated with seborrheic dermatitis (PRR 1.9, 95% CI: 1.3-2.8 and PRR 2.2, 95% CI: 1.4-3.3, respectively) and with eczema nummulare (PRR 1.7, 95% CI: 0.9-3.1 and PRR 1.7, 95% CI: 0.9-3.3, respectively). For non-smokers, the corresponding estimates were 1.7 for seborrheic dermatitis (95% CI: 1.1-2.6) and 1.8 (95% CI: 1.1-3.1) and 1.4 for eczema nummulare (95% CI: 0.7-2.9) and 1.2 (95% CI: 0.5-2.9), respectively. No association was found between bleeding-deepened periodontal pockets and atopic dermatitis. Further adjustments for C-reactive protein, diabetes, and inflammatory diseases did not essentially change the risk estimates among either the total population or the non-smokers. Bleeding periodontal pockets appeared to be associated with the presence of seborrheic dermatitis and eczema nummulare.

Interstitial Lung Disease in Firefighters: An Emerging Occupational Hazard.

IntroductionOccupational risk factors for interstitial lung disease (ILD) are a remediable aspect of this progressive pulmonary disorder. The association between firefighting and ILD is unknown. Our objective was to assess the characteristics of firefighters with ILD from a large single-center ILD registry.MethodsThe University of Chicago ILD database was reviewed for patients with a history of firefighting. Clinical information was abstracted from the medical record. The prevalence rate ratio of firefighters in the database compared to the baseline prevalence of firefighting in the Chicago metropolitan area was calculated via the Poisson distribution.ResultsNineteen firefighters were identified; all were men. A variety of ILD subtypes were seen across the cohort, including four patients with a diagnosis of connective tissue disease. Patients had mild forced vital capacity (FVC) and moderate diffusing capacity for carbon monoxide (DLCO) decrements on presentation; three patients died and two received lung transplantation over an average follow-up time of 76 months. Firefighters were seen at a greater proportion in the ILD registry than in the general population with a prevalence rate ratio of 3.98.ConclusionsFirefighting was overrepresented in our cohort compared to the general population, suggesting that there may be a causative association between firefighting and the presence of ILD. The wide variety of ILD subtypes observed suggest that all ILD patients should be asked about their occupational history. Further investigation to identify occupational exposures and determine the benefit of remediation is needed.

Prevalence and Trends in Antimicrobial Susceptibility Patterns of Multi-Drug-Resistance Non-Typhoidal Salmonella in Central Thailand, 2012-2019.

PurposeMulti-drug resistance of non-typhoidal Salmonella (MDR-NTS) is an increasing threat worldwide. In Thailand, data for the past decade is limited. This research is to determine the prevalence and trends of nonsusceptibility patterns of the bacteria, especially to ciprofloxacin and ceftriaxone.MethodsThis retrospective study was extracted data of patients who had non-typhoidal Salmonella (NTS) infection, from 10 hospitals between June 2011 and June 2020. Demographic data, culture reports, and antimicrobial susceptibility were included in the analysis.ResultsA total of 433 patients were identified. The most common age group was less than 15 years old (53.6%), with a median age of 12 years (IQR 57–4). Of these people, 61.1% had gastroenteritis and 36.7% had bacteremia. The most prevalent serogroups was C (28.6%). MDR-NTS rate was 52.8% (95% CI 39–44). The resistant rates were 43%, 32.8%, 22.8%, 6.7%, 4%, 0.45%, 0.45% for sulfamethoxazole/trimethoprim, amoxicillin-clavulanic acid, cefotaxime, ampicillin/sulbactam, piperacillin/tazobactam, imipenem and meropenem retrospectively. Resistant rates have been increasing, especially for ciprofloxacin (30%), which rose from 16.6% in 2011–2015 to 39.5% in 2016–2020 (prevalence rate ratio (PRR) 2.4,95% CI 1.51–3.72) and for ceftriaxone 25.4% which rose from 16.1% to 32% (PRR 2 95% CI 1.24–3.16). Ampicillin, norfloxacin, tetracycline, amikacin, gentamicin, and ceftazidime remained static at 62.3%, 49.5%, 33.2%, 15.2%, 8.8%, 2.8%, respectively.ConclusionThe prevalence of MDR-NTS has been increasing over the past decade, particularly those strains which demonstrate resistance to ciprofloxacin and ceftriaxone. Finding successful treatment requires a comprehensive selection of proper antimicrobials as well as close monitoring, especially in cases with severe infection.

Malaria transmission and prevalence in rice-growing versus non-rice-growing villages in Africa: a systematic review and meta-analysis

SummaryBackgroundRice fields in Africa are major breeding sites for malaria vectors. However, when reviewed in the 1990s, in settings where transmission was relatively intense, there was no tendency for malaria indices to be higher in villages with irrigated rice fields than in those without. Subsequently, intervention coverage in sub-Saharan Africa has been massively scaled up and malaria infection prevalence has halved. We re-examined this rice–malaria relationship to assess whether, with lower malaria transmission, malaria risk is greater in rice-growing than in non-rice-growing areas.MethodsFor this systematic review and meta-analysis, we searched EMBASE, Global Health, PubMed, Scopus, and Web of Science to identify observational studies published between Jan 1, 1900, and Sept 18, 2020. Studies were considered eligible if they were observational studies (cross-sectional, case-control, or cohort) comparing epidemiological or entomological outcomes of interest between people living in rice-growing and non-rice-growing rural communities in sub-Saharan Africa. Studies with pregnant women, displaced people, and military personnel as participants were excluded because they were considered not representative of a typical community. Data were extracted with use of a standardised data extraction form. The primary outcomes were parasite prevalence (P falciparum parasite rate age-standardised to 2–10-year-olds, calculated from total numbers of participants and number of infections [confirmed by microscopy or rapid diagnostic test] in each group) and clinical malaria incidence (number of diagnoses [fever with Plasmodium parasitaemia confirmed by microscopy or rapid diagnostic test] per 1000 person-days in each group). We did random-effects meta-analyses to estimate the pooled risk ratio (RR) for malaria parasite prevalence and incidence rate ratio (IRR) for clinical malaria in rice-growing versus non-rice-growing villages. RRs were compared in studies conducted before and after 2003 (chosen to mark the start of the mass scale-up of antimalaria interventions). This study is registered with PROSPERO (CRD42020204936).FindingsOf the 2913 unique studies identified and screened, 53 studies (including 113 160 participants across 14 African countries) were eligible for inclusion. In studies done before 2003, malaria parasite prevalence was not significantly different in rice-growing versus non-rice-growing villages (pooled RR 0·82 [95% CI 0·63–1·06]; 16 studies, 99 574 participants); however, in post-2003 studies, prevalence was significantly higher in rice-growing versus non-rice growing villages (1·73 [1·01–2·96]; seven studies, 14 002 participants). Clinical malaria incidence was not associated with residence in rice-growing versus non-rice-growing areas (IRR 0·75 [95% CI 0·47–1·18], four studies, 77 890). Potential limitations of this study include its basis on observational studies (with evidence quality rated as very low according to the GRADE approach), as well as its omission for the effects of seasonality and type of rice being cultivated. Risk of bias and inconsistencies was relatively serious, with I2 greater than 90% indicating considerable heterogeneity.InterpretationIrrigated rice-growing communities in sub-Saharan Africa are exposed to greater malaria risk, as well as more mosquitoes. As increasing rice production and eliminating malaria are two major development goals in Africa, there is an urgent need to improve methods for growing rice without producing mosquitoes.FundingWellcome Trust Our Planet Our Health programme, CGIAR Agriculture for Nutrition and Health.

The neglected epidemic-Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study.

In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical "hotspots" of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the "Beira corridor" (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the "Beira corridor", higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.

Access to food and health care during the COVID-19 pandemic by disability status in the United States

BackgroundThe COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers. Objective/HypothesisTo examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability. MethodsWe used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability. ResultsDuring April 14–26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67–1.96), and delay (range of PRR: 1.48–1.87) or not get (range of PRR: 1.60–2.07) needed medical care. ConclusionsThese disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.

Diagnosing pancreatic cancer in general practice: a cross-sectional study on associations between suspicion of cancer, urgent referral and time to diagnosis

Objective This study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP’s suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval. Design Cross-sectional study combining register and survey data. Patients Patients with incident pancreatic cancer recorded in the Danish National Patient Register (n = 303). Main outcome measures The patient’s first point of symptoms presentation, GP’s cancer suspicion, CPP referral and diagnostic interval. Results General practice was the first point of contact for 85.5% of the population. At the first consultation, cancer was suspected in 32.7% and 22.9% were referred to a CPP. The GPs were more likely to suspect cancer or serious illness in patients aged >70 years (prevalence rate ratio (PRR) 1.34, 95% CI 1.09–1.66) and among patients with high comorbidity (PRR 1.23, 95% CI 1.04–1.47). A CPP referral was less likely among patients with low education. The median diagnostic interval was 39 days (interquartile range: 15–72). When the GP initially did not suspect cancer, the likelihood of longer diagnostic interval increased. Conclusion The majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice. Key points Patients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage. The majority of patients with pancreatic cancer began their diagnostic process in general practice. General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients. The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis.

IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria

AimsThe approaches used to screen and diagnose gestational diabetes mellitus (GDM) vary widely. We generated a comparable estimate of the global and regional prevalence of GDM by International Association of Diabetes in Pregnancy Study Group (IADPSG)'s criteria. MethodsWe searched PubMed and other databases and retrieved 57 studies to estimate the prevalence of GDM. Prevalence rate ratios of different diagnostic criteria, screening strategies and age groups, were used to standardize the prevalence of GDM in individual studies included in the analysis. Fixed effects meta-analysis was conducted to estimate standardized pooled prevalence of GDM by IDF regions and World Bank country income groups. ResultsThe pooled global standardized prevalence of GDM was 14.0% (95% confidence interval: 13.97–14.04%). The regional standardized prevalence of GDM were 7.1% (7.0–7.2%) in North America and Caribbean (NAC), 7.8% (7.2–8.4%) in Europe (EUR), 10.4% (10.1–10.7%) in South America and Central America (SACA), 14.2% (14.0–14.4%) in Africa (AFR), 14.7% (14.7–14.8%) in Western Pacific (WP), 20.8% (20.2–21.4%) in South-East Asia (SEA) and 27.6% (26.9–28.4%) in Middle East and North Africa (MENA). The standardized prevalence of GDM in low-, middle- and high-income countries were 12.7% (11.0–14.6%), 9.2% (9.0–9.3%) and 14.2% (14.1–14.2%), respectively. ConclusionsThe highest standardized prevalence of GDM was in MENA and SEA, followed by WP and AFR. Among the three World Bank country income groups, high income countries had the highest standardized prevalence of GDM. The standardized estimates for the prevalence of GDM provide an insight for the global picture of GDM.

803. The Impact of Bundled Interventions to Decrease Transmission of Drug-Resistant Pseudomonas aeruginosa from Wastewater Drain Sites on a Hematologic Malignancy/Hematopoietic Stem Cell Transplant Unit

BackgroundWastewater drain (WWD) sites are an important reservoir for amplification, propagation and transmission of multidrug resistant organisms. We observed an increase in the incidence of carbapenem and fluoroquinolone non-susceptible (CP-NS and FQ-NS) P. aeruginosa bloodstream infections (BSI) among patients on our hematologic malignancies (HM) and hematopoietic cell transplant (HCT) unit. The incidence of CP-NS/FQ-NS P. aeruginosa BSI from 2012 through May 2021 is represented in Figure 1. We sought to determine the impact of low-cost, low-barrier interventions targeting WWD sites on the prevalence of patient and environmental P. aeruginosa colonization and incidence of BSI.Figure 1. Incidence of P. aeruginosa BSI, 2012 through May 2021 MethodsBehavioral and structural interventions to limit acquisition from WWD sites were informed by an environmental analysis and rolled out in staged fashion beginning in September 2019. Pre- and post-intervention colonization surveys were performed on the unit to assess for patient and WWD site P. aeruginosa colonization. Whole genome sequencing (WGS) was performed on select isolates. A sensitivity analysis performed accounted for the unconfirmed patient isolates. BSI data was collected retrospectively. ResultsCharacteristics of the pre- and post-intervention groups are presented in Table 1. Five of 27 (18.5%) and 1 of 26 (3.8%) patients in the pre- and post-intervention point prevalence survey, respectively, were confirmed to be colonized with P. aeruginosa (Figure 2), corresponding to a prevalence rate ratio of 0.21 (0.03,1.66). If the two indeterminate samples in the pre-intervention period were positive, the prevalence rate ratio would instead be 0.15 (0.02,1.12). The most frequent P. aeruginosa strains identified by WGS from the patients and environment were 111, 308 and 446. At least 87% of rooms were colonized with P. aeruginosa from at least one WWD site, from pre- and post-intervention periods (Table 2). Table 1. Demographic and clinical characteristics of patients in each epoch. Results are given as percent (frequency) unless otherwise noted. Chi square test was used unless otherwise noted. Figure 2. Proportion of patients colonized with P. aeruginosa Positive: Colonized with P. aeruginosa, confirmed by WGS; Unknown: Phenotype of isolate suggestive of P. aeruginosa, WGS not performed; Negative: No growth on selective agar or non-P aeruginosa identification on WGS Table 2. WWD site colonization, by phenotypic and WGS determination. Fisher’s exact test was used unless otherwise noted. Conclusion P. aeruginosa WWD colonization on our HM/HCT unit may predispose patients to colonization and BSI. The prevalence of patient colonization decreased following implementation of the interventions, despite persistent environmental colonization. We will follow the incidence of P. aeruginosa BSI to determine the long-term impact of these interventions. Disclosures All Authors: No reported disclosures

Examining the Drivers of Racial/Ethnic Disparities in Non-Adherence to Antihypertensive Medications and Mortality Due to Heart Disease and Stroke: A County-Level Analysis.

Background: Prior research has identified disparities in anti-hypertensive medication (AHM) non-adherence between Black/African Americans (BAAs) and non-Hispanic Whites (nHWs) but the role of determinants of health in these gaps is unclear. Non-adherence to AHM may be associated with increased mortality (due to heart disease and stroke) and the extent to which such associations are modified by contextual determinants of health may inform future interventions. Methods: We linked the Centers for Disease Control and Prevention (CDC) Atlas of Heart Disease and Stroke (2014–2016) and the 2016 County Health Ranking (CHR) dataset to investigate the associations between AHM non-adherence, mortality, and determinants of health. A proportion of days covered (PDC) with AHM < 80%, was considered as non-adherence. We computed the prevalence rate ratio (PRR)—the ratio of the prevalence among BAAs to that among nHWs—as an index of BAA–nHW disparity. Hierarchical linear models (HLM) were used to assess the role of four pre-defined determinants of health domains—health behaviors, clinical care, social and economic and physical environment—as contributors to BAA–nHW disparities in AHM non-adherence. A Bayesian paradigm framework was used to quantify the associations between AHM non-adherence and mortality (heart disease and stroke) and to assess whether the determinants of health factors moderated these associations. Results: Overall, BAAs were significantly more likely to be non-adherent: PRR = 1.37, 95% Confidence Interval (CI):1.36, 1.37. The four county-level constructs of determinants of health accounted for 24% of the BAA-nHW variation in AHM non-adherence. The clinical care (β = −0.21, p < 0.001) and social and economic (β = −0.11, p < 0.01) domains were significantly inversely associated with the observed BAA–nHW disparity. AHM non-adherence was associated with both heart disease and stroke mortality among both BAAs and nHWs. We observed that the determinants of health, specifically clinical care and physical environment domains, moderated the effects of AHM non-adherence on heart disease mortality among BAAs but not among nHWs. For the AHM non-adherence-stroke mortality association, the determinants of health did not moderate this association among BAAs; the social and economic domain did moderate this association among nHWs. Conclusions: The socioeconomic, clinical care and physical environmental attributes of the places that patients live are significant contributors to BAA–nHW disparities in AHM non-adherence and mortality due to heart diseases and stroke.

Illness prevalence and symptoms in youth floorball players: a one-season prospective cohort study involving 471 players

ObjectiveTo describe weekly illness prevalence and illness symptoms by sex in youth floorball players during one season.DesignProspective cohort study.SettingPlayers who were registered to play community level floorball during the 2017–2018...

Relationship Between Recreational Cannabis Use and Helicobacter pylori Infection.

Background: Cannabis plant extracts suppress gastric acid secretion and inflammation, and promote gastroduodenal ulcer healing, all of which are triggered by Helicobacter Pylori infection (HPI). Here, we evaluate the association between cannabis use and HPI among a representative community sample. Materials and Methods: We identified respondents who completed cannabis use questions and were tested for HPI (H. pylori IgG antibody seropositivity) from the National Health and Nutrition Examination Survey III dataset (n=4556). Cannabis usage was categorized as ever-use (ever, never), cumulative lifetime use (>10-times, 1-10-times, never), or recent use (>31-days-ago, within-31-days, never). We calculated the crude and adjusted risk (prevalence rate ratio, cPRR and aPRR) of having HPI with cannabis use using generalized Poisson models (SAS 9.4). The models were adjusted for demographics and risk factors for HPI. Results: The prevalence of HPI was lower among ever versus never cannabis users (18.6% vs. 33%, p<0.0001). Cannabis use was associated with a decreased risk of HPI (cPRR: 0.56 confidence interval [95% CI: 0.47-0.67]; p<0.0001), which persisted after adjusting for demographics (aPRR: 0.75 [95% CI: 0.63-0.90]; p=0.0016) and comorbidities (aPRR: 0.79 [95% CI: 0.66-0.95]; p=0.0145). Further, individuals with >10-times lifetime cannabis use had a decreased risk of HPI compared with those with 1-10-times lifetime use (aPRR: 0.70 [95% CI: 0.55-0.89]; p=0.0011) and never-users (aPRR: 0.65 [95% CI: 0.50-0.84]; p=0.0002). Conclusion: Recreational cannabis use is associated with diminished risk of HPI. These observations suggest the need for additional research assessing the effects of medical cannabis formulations on HPI.

Prevalence, seasonal variation and nature of illness in youth floorball players: a prospective cohort study

Introduction: Acute illness presents a significant health burden to athletes, including training interference, impaired performance, time-loss from competition and increased subsequent injury risk. Although most youth participate in sport at recreational level, illness epidemiology in this population during a season or competition has not been well studied to direct prevention initiatives. We aim to provide a first detail profile of illness and illness symptoms by sex in Swedish youth floorball players during one season. Methods: This prospective cohort study was part of a Sport Without Injury ProgrammE cluster randomised controlled trial in floorball evaluating the efficacy of the Knee Control injury prevention exercise programme. Weekly illness data were collected from youth players during the 2017-2018 season (26 weeks) using the Oslo Sports Trauma Research Center questionnaire on health problems. Illness symptoms were grouped into clusters according to the 2020 International Olympic Committee consensus recommendations. Sex differences in average weekly illness prevalence was compared with a prevalence rate ratio and corresponding 95% CI, and proportion of reported illness symptoms with the chi-square test. Results: The mean age for 329 male and 142 female players was 13.3(SD 1.0) and 13.7(SD 1.5) years, respectively. The mean number of weekly reports per player was 14.4(SD 7.8) (13.5(SD 8.1) males vs 16.3(SD 6.8) females). 61% of players (60% males vs 64% females) reported at least one illness week during the season. The average weekly illness prevalence was 12%(95% CI 10.8-12.3%) for all players, and slightly higher in females (13%, 95% CI 11.6-14.3%) than males (11%, 95% CI 9.9-11.7%), prevalence rate ratio 1.20(95% CI 1.05-1.37, p=0.009). 49%(53% males, 43% females) of illness reports indicated time-loss from sport. Illness prevalence was highest in calendar weeks 4-7 (peak winter weeks) and ranged from 15%-18%(20%-23% females vs 12%-17% males) during this period. Upper/lower respiratory symptoms (fever (30%), sore throat (16%) and cough (14%) were common). More females (16% vs 3% males, p<0.001) reported difficulty of breathing/tight airways. 7% females and no males reported fainting. Discussion: Two third of players reported at least one illness. Flu-like symptoms dominated the season. Athletes, coaches, parents and support personnel need to be aware of risk of infections and educated about risk mitigation of viral infections. Improved awareness of self-monitoring of respiratory symptoms could help reduce the risk of spreading the infection to team members. Conflict of interest statement: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.