Regional Variation In Prevalence Research Articles

Gouty Arthritis Across Ages: Understanding Disease Patterns and Predictors.

Introduction Gout, a chronic inflammatory joint disease, is increasingly prevalent worldwide, mainly affecting men, young females,and post-menopausal women. This study aims to investigate gout epidemiology in Al-Baha, Saudi Arabia, addressing the dearth of localized data on prevalence, risk factors, and management practices. Methods Across-sectional analysis was conducted at King Fahad Hospital, Al-Baha, Saudi Arabia, covering 116 patients from March 2016 to November 2017. Data encompassed demographics, clinical presentations, and biochemical markers relevant to gout. Results Among 116 patients, 41 (35.3%) were diagnosed with gout, with males exhibiting a significantly higher prevalence than females (43.9% vs. 24%). Significant associations were found between gout prevalence and residency, occupational status, education level, clinical presentations (podagra, arthralgia/arthritis), and biochemical markers. Conclusion This study enriches global knowledge by providing localized insights into gout's epidemiology and highlighting demographic influences and clinical presentations specific to the Saudi context. The findings underscore the importance of tailored approaches in gout management, considering regional variations in prevalence, risk factors, and clinical manifestations.

Assessment of Babesia spp. prevalence in various domestic animals across Southern Punjab, Pakistan.

Parasitic diseases, notably babesiosis, exert a substantial impact on the global cattle industry, posing challenges to commerce, economies, and human health. This study, conducted in Southern Punjab, Pakistan, aimed to assess the prevalence of Babesia spp. across various livestock species using microscopic and PCR methods. A total of 180 blood samples (60 from each district) were systematically collected from apparently healthy animals, with 36 samples obtained from each domestic animal species, including camel, cattle, buffalo, goat, and sheep, noting that 12 samples were collected from each district for each animal species. Overall prevalence was determined to be 32.8% (59/180), with varying rates among species: 25.0% in cattle, 41.66% in buffalo, 30.55% in goats, 33.3% in sheep, and 33.3% in camels. Microscopic examination revealed slightly varied infection rates among large and small domestic animals (22.2%), while PCR results indicated a 32.8% overall infection rate in both large and small domestic animals, with no statistical significance. District-wise analysis showed regional variations, with Muzaffargarh recording a prevalence rate of 23.33% through microscopic examination, while Lodhran and Bahawalpur recorded 21.67%. PCR results revealed higher rates (38.33%, 26.67%, and 33.33%, respectively), underlining the importance of employing PCR for accurate detection. Examining ruminant types, large ruminants exhibited a 32.4% infection rate, while small domestic animals showed 33.3%, with no significant difference (p=0.897). District-wise prevalence showcased significant variation, with Muzaffargarh demonstrating a 25% prevalence, Lodhran 22%, and Bahawalpur 22%, through microscopic examination. PCR results displayed 38.33%, 27%, and 33.3%, respectively, with no statistical significance. Detailed analysis of individual districts highlighted variations in infection rates among camels, cattle, buffalo, goats, and sheep. The binomial test indicated significant differences through microscopic analysis (P=0.011) but non-significant variations through PCR (P=0.065), emphasizing the precision of PCR. Regional variations in prevalence, notably with Punjab exhibiting the highest frequency (33.87%) and KPK the lowest (13.24%), suggest potential influences from varying veterinary practices and environmental factors. This study underscores the pivotal role of PCR alongside microscopy for accurate babesiosis diagnosis. These findings contribute to the broader understanding of babesiosis prevalence, emphasizing the necessity of advanced molecular techniques for informed control measures.

Prevalence of neurodevelopmental differences and autism in Scottish primary schools 2018-2022.

This study investigated the prevalence of neurodevelopmental needs among children in primary schools in Scotland. Two groups were identified: autistic learners and a larger group of learners who had neurodevelopmental differences. These differences encompassed any need for additional support in various domains, including communication, interaction, emotional regulation, coordination, movement, and cognition. A two-phase process was employed, drawing on data from a cross-sectional study followed by a secondary analysis of a population census. In the first phase, a random sample of 688 children with additional support needs from 22 schools participated. Demographics, support characteristics, and neurodevelopmental needs were identified. Results revealed that 76.89% of children with additional support needs exhibited a need type consistent with a neurodevelopmental difference. In the second phase, data from the Scottish Government Annual Pupil Census, covering all state-provided primary school children between 2018 and 2022, were analyzed. Modeling was conducted using data from the first phase to estimate prevalence of neurodevelopmental differences. Data on autism were directly extracted from the census. Analysis revealed an increase in the prevalence of neurodevelopmental differences and autism. The prevalence of autism rose by 31.98%, with 2.60% of primary school children identified as autistic in 2022. Similarly, the prevalence of neurodevelopmental differences increased by 10.57%, with 16.22% of primary school children exhibiting such differences in 2022. Across 32 localities, regional variations in prevalence were observed. These findings show the substantial number of neurodivergent children within Scottish primary schools and emphasize the need for a neurodevelopmentally informed approach to inclusive education.

Use of antianemics in prenatal care: A population cohort from a capital city in the North region of Brazil

Anemia during pregnancy is a significant risk factor for adverse maternal and fetal outcomes, including preterm birth, low birth weight, and maternal mortality. In Brazil, anemia prevention and treatment programs are available, but regional variations in prevalence and factors associated with antianemic drug use remain understudied. The objective was to identify the prevalence of gestational anemia and the factors associated with the use of antianemic drugs during pregnancy in a cross-sectional population-based study carried out in Rio Branco, AC. To do so, we planned a cross-sectional, population-based study with a total of 1190 postpartum women who gave birth between April 6 and July 10, 2015, were interviewed about demographic, socioeconomic, reproductive, and prenatal care factors. The prevalence of anemia during pregnancy was found to be 13.8 %, with 93.2 % of women using antianemic drugs, such as ferrous sulfate and folic acid. Factors positively associated with antianemic drug use were higher education (elementary school II RCajust = 2.46; 95 %, CI: 1.01–6.13; high school RCajust = 2.61; 95 %, CI: 1.11–6.12), primiparity (ACadjust = 1.69; 95 %, CI: 0.98–3.74), 6 to 8 prenatal consultations (ACjust = 2.16; 95, CI%: 1.15–4.05), and planned pregnancy (ARjust = 1.94; 95 %, CI: 1.05–3.74). Food security during pregnancy was inversely associated. These findings suggest that while anemia prevention and treatment programs exist, more targeted strategies are needed, particularly for women with lower socioeconomic status, to improve maternal and fetal health outcomes.

Association of Psychosocial Stress With Risk of Acute Stroke

Psychosocial stress is considered a modifiable risk factor for stroke. Given the prevalence of chronic and acute exposure to stress, it represents a potentially attractive target for population-health interventions. To determine the association of psychosocial stress with the risk of acute stroke and explore factors that might modify the association of stress with risk of acute stroke in a large international population. INTERSTROKE is an international retrospective case-control study of risk factors for first acute stroke in 32 countries in Asia, North and South America, Europe, Australia, the Middle East, and Africa. A total of 13 462 patients with stroke and 13 488 matched controls were recruited between January 11, 2007, and August 8, 2015. The present analyses were performed from June 1 to 30, 2021, and included 13 350 cases and 13 462 controls with available data on psychosocial stress. Psychosocial stress and occurrence of stressful life events within the preceding year were measured using a standardized questionnaire of self-reported stress at home and work. The association of stress with acute stroke and its subtypes was examined using multivariable conditional logistic regression and factors that might modify the association, particularly self-reported locus of control. Among 26 812 participants included in the analysis, the mean (SD) age of cases was 62.2 (13.6) years; that of controls, 61.3 (13.3) years; 7960 cases (59.6%) and 8017 controls (59.6%) were men. Several periods of stress and permanent stress were reported for 2745 cases (20.5%) and 1933 controls (14.4%), with marked regional variation in prevalence, with the lowest in China (201 of 3981 [5.0%] among controls and 364 of 3980 [9.1%] among cases) and highest in South East Asia (233 of 855 [26.1%] among controls and 241 of 782 [30.8%] among cases). Increased stress at home (odds ratio [OR], 1.95 [95% CI, 1.77-2.15]) and at work (OR, 2.70 [95% CI, 2.25-3.23]) and recent stressful life events (OR, 1.31 [95% CI, 1.19-1.43]) were associated with an increased risk of acute stroke on multivariable analyses (vs no self-reported stress). Higher locus of control at home was associated with a reduced odds of all stroke (OR, 0.73 [95% CI, 0.68-0.79]), and higher locus of control both at work and at home were associated with a lower odds of acute stroke and significantly diminished the association with stress at work (OR, 2.20 [95% CI, 1.88-2.58]; P = .008 for interaction) and home (OR, 1.69 [95% CI, 1.44-1.98]; P < .001 for interaction) for acute stroke. Psychosocial stress is a common risk factor for acute stroke. The findings of this case-control study suggest that higher locus of control is associated with lower risk of stroke and may be an important effect modifier of the risk associated with psychosocial stress.

Regional variation in prevalence of difficult-to-treat asthma and oral corticosteroid use for patients in Australia: heat map analysis

Background In Australia, the regional prevalence of difficult-to-treat asthma is unknown. We aimed to describe regional variation in difficult-to-treat asthma prevalence and oral corticosteroid (OCS) use. Methods In this retrospective, observational, longitudinal study using data from March 2018–February 2019 in the NostraData longitudinal database, prescriptions dispensed for obstructive airway disease were processed through a high-level algorithm to identify patients with asthma. Difficult-to-treat asthma was defined by ≥2 high-dosage inhaled corticosteroids plus long-acting beta-agonist prescriptions over 6 months. Patients who additionally received OCS prescriptions sufficient to treat ≥2 exacerbations over 6 months were classified as having uncontrolled difficult-to-treat asthma. Patient-level data were analyzed across 340 geographic areas in Australia to determine regional prevalence of difficult-to-treat asthma, uncontrolled difficult-to-treat asthma, and OCS use. Results Of 1 851 129 people defined as having asthma, 440 800 (24%) were classified as having difficult-to-treat disease. Of those difficult-to-treat asthma patients, 96 338 (22%) were considered to have uncontrolled disease. Between 29% and 48% of patients had difficult-to-treat asthma in 49 geographic areas, most frequently located in Western Australia. Between 26% and 67% of patients had uncontrolled difficult-to-treat asthma in 29 geographic areas (mostly in Eastern Australia). Overall, a wide variability of asthma severity and control was observed among regions. Conclusions Despite global and national guidelines, regional differences in the prevalence of difficult-to-treat asthma and uncontrolled difficult-to-treat asthma and OCS use exist in Australia. Understanding these regional variations should inform policy and target management in the areas with the greatest unmet need.

Update on thyroid eye disease: Regional variations in prevalence, diagnosis, and management.

Thyroid eye disease (TED) is a rare disease that can lead to decreased quality of life, permanent disfigurement, and vision loss. Clinically, TED presents with exophthalmos, periorbital edema, extraocular muscle dysfunction, and eyelid retraction, and can lead to vision-threatening complications such as exposure to keratopathy and dysthyroid optic neuropathy (DON). Over the last several years, significant advancements have been made in the understanding of its pathophysiology as well as optimal management. Ethnic variations in the prevalence, clinical presentation, and risk of vision-threatening complications of TED are summarized, and risk factors associated with TED are discussed. Additionally, significant advances have been made in the management of TED. The management of TED traditionally included anti-inflammatory medications, orbital radiation therapy, orbital surgical decompression, and biologic therapies. Most recently, targeted therapies such as teprotumumab, an insulin-like growth factor-1 receptor antagonist, have been studied in the context of TED, with promising initial data. In this review, updates in the understanding and management of TED are presented with a focus on the international variations in presentation and management.

Spatial epidemiologic analysis of the liver cancer and gallbladder cancer incidence and its determinants in South Korea

BackgroundThere have been reports on regional variation in prevalence of hepatitis B and C, and Clonorchis sinensis (C. sinensis) infection, which indicates potential of spatial variation in liver cancer and gallbladder cancer incidence in Korea. Therefore, we aimed to assess the regional variation of liver and gallbladder cancer incidence and its determinants based on the regional distribution of risk factors, including hepatitis B infection in Korea.MethodsThis study used an ecological study design and district-level cancer incidence statistics generated by the National Cancer Center. Spatial clusters of liver and gallbladder cancer incidence were detected based on spatial scan statistics using SaTScan™ software. We set the size of maximum spatial scanning window of 25 and 35% of the population at risk for analyses of liver and gallbladder cancer, respectively. Significance level of 0.05 was used to reject the null hypothesis of no cluster. We fitted the Besag-York-Mollie model using integrated nested Laplace approximations to assess factors that influence the regional variation in cancer incidence.ResultsSpatial clusters with high liver cancer incidence rates were detected in the southwestern and southeastern regions of Korea. High gallbladder cancer incidence rates are clustered in the southeastern region. Regional liver cancer incidence can be accounted for the prevalence of high household income (coefficient, − 0.10; 95% credible interval [CI], − 0.18 to − 0.02), marital status (coefficient, − 0.14; 95% CI, − 0.25 to − 0.03), the incidence of hepatitis B (coefficient, 0.87; 95% CI, 0.29 to 1.44), and liver cancer screening (coefficient, 0.06; 95% CI, 0.00 to 0.12), while gallbladder cancer incidence was related to the prevalence of high household income (coefficient, − 0.03; 95% CI, − 0.05 to 0.00) and living close to a river with a high prevalence of liver fluke infection (coefficient, 0.55; 95% CI, 0.14 to 0.96).ConclusionsThis study demonstrated geographic variation in liver and gallbladder cancer incidence, which can be explained by determinants such as hepatitis B, income, marital status, and living near a river.

Pupils returning to primary schools in England during 2020: rapid estimations of punctual COVID-19 infection rates

Drawing on risk methods from volcano crises, we developed a rapid COVID-19 infection model for the partial return of pupils to primary schools in England in June and July 2020, and a full return in September 2020. The model handles uncertainties in key parameters, using a stochastic re-sampling technique, allowing us to evaluate infection levels as a function of COVID-19 prevalence and projected pupil and staff headcounts. Assuming average national adult prevalence, for the first scenario (as at 1 June 2020) we found that between 178 and 924 [90% CI] schools would have at least one infected individual, out of 16 769 primary schools in total. For the second return (July), our estimate ranged between 336 (2%) and 1873 (11%) infected schools. For a full return in September 2020, our projected range was 661 (4%) to 3310 (20%) infected schools, assuming the same prevalence as for 5 June. If national prevalence fell to one-quarter of that, the projected September range would decrease to between 381 (2%) and 900 (5%) schools but would increase to between 2131 (13%) and 9743 (58%) schools if prevalence increased to 4× June level. When regional variations in prevalence and school size distribution were included in the model, a slight decrease in the projected number of infected schools was indicated, but uncertainty on estimates increased markedly. The latter model variant indicated that 82% of infected schools would be in areas where prevalence exceeded the national average and the probability of multiple infected persons in a school would be higher in such areas. Post hoc, our model projections for 1 September 2020 were seen to have been realistic and reasonable (in terms of related uncertainties) when data on schools' infections were released by official agencies following the start of the 2020/2021 academic year.

Trends and Regional Variation in Prevalence of Cardiovascular Risk Factors and Association With Socioeconomic Status in Canada, 2005-2016

Cardiovascular disease remains the second leading cause of death in Canada. Monitoring and tracking the trends and disparities in major cardiovascular risk factors could provide benchmarks for future cardiovascular health strategies. To investigate the temporal trends, regional variations, and socioeconomic disparities in major cardiovascular risk factors in Canada from 2005 to 2016. This repeated cross-sectional survey study included adults aged 20 years and older from 6 Canadian Community Health Survey cycles between 2005 and 2016. Cardiovascular risk factors included hypertension, diabetes, obesity, and current smoking. Socioeconomic status was measured using equivalized household income. Data analysis was performed from September 2019 to April 2020. A total of 112 health regions and socioeconomic status. Age- and sex-adjusted prevalence of hypertension, diabetes, obesity, and current smoking by year; health regions; and socioeconomic status. Absolute numbers were rounded to base 100 for confidentiality purposes, and percentages were based on weighted numbers. Slope index of inequality (SII) and relative index of inequality (RII) were calculated to assess absolute and relative socioeconomic inequalities, respectively. A total of 670 000 respondents (329 000 [49.1%] men; 341 000 [50.9%] women) aged 20 years and older from 6 survey cycles were enrolled for this study. The largest age group was those aged 40 to 59 years (eg, 2005 cycle: 40.2% [95% CI, 39.9%-40.6%]). In the 2015/2016 cycle, the overall age- and sex-adjusted prevalence rates of hypertension, diabetes, obesity, and current smoking were 20.7% (95% CI, 20.4%-21.1%), 7.2% (95% CI, 7.0%-7.5%), 20.1% (95% CI, 19.7%-20.6%), and 17.8% (95% CI, 17.4%-18.2%), respectively. From 2005 to 2016, there was a significant increase in the prevalence of hypertension, diabetes, and obesity (eg, prevalence of diabetes in both sexes, 2005: 5.8% [95% CI, 5.6%-6.0%]; 2015/2016: 7.2% [95% CI, 7.0%-7.5%]; P < .001) but a significant decrease in the prevalence of current smoking (both sexes, 2005: 22.1% [95% CI, 21.7%-22.5%]; 2015/2016: 17.8% [95% CI, 17.4%-18.2%]; P < .001). The prevalence of all the risk factors varied widely across health regions (eg, obesity, Vancouver Health Service Delivery Area: 6.7% [95% CI, 4.5%-9.0%]; Miramichi Area: 36.8% [95% CI, 27.3%-46.3%]). In addition to obesity among men, all risk factors tended to be more common among those with lower income (eg, prevalence of hypertension in both sexes, 2015/2016, lowest income group: 23.2% [95% CI, 22.4%-24.0%]; highest income group: 18.4% [95% CI, 17.7%-19.1%]). The SII and RII indicated consistent absolute and relative socioeconomic inequalities in hypertension, diabetes, and current smoking over time (eg, RII for hypertension in both sexes, 2005: 1.25; 95% CI, 1.18-1.33; 2015/2016: 1.34; 95% CI, 1.26-1.43). However, the phenomenon of absolute and relative socioeconomic inequalities in obesity was only observed among women (eg, RII for 2015/2016 for obesity in women; 1.74 (95% CI, 1.56-1.93); men: 1.09; 95% CI, 0.99-1.21). During the study period, the prevalence of hypertension, diabetes, and obesity significantly increased, while the prevalence of current smoking significantly decreased. Geographic and socioeconomic gaps should be considered and addressed in future interventions and policies targeted at reducing these cardiovascular risk factors in Canada.

The translocation t(1;19)(q23;p13) (TCF3/PBX1 fusion) is the most common recurrent genetic abnormality detected amongst patients with B-cell lymphoblastic leukaemia in Johannesburg, South Africa

Background: B-cell lymphoblastic leukaemia (B-ALL) is a malignancy of immature B-cells with several described recurrent genetic abnormalities. These have distinct clinico-pathological associations and show regional variation in prevalence. In all previously reported series, the translocation t(1;19) is uncommon, comprising 10% of all cases. The genetic composition of B-ALL in Africa is unknown.Aim: The aim of this study was to assess the genetic landscape of B-ALL in Johannesburg, South Africa.Setting: The Johannesburg state-sector.Methods: All cases of B-ALL diagnosed by flow cytometry in the state-sector hospitals of Johannesburg over 36 months between 2016 and 2019 were identified and pertinent data were recorded from the laboratory information system.Results: A total of 108 patients with B-ALL were identified, 82 (75.9%) of whom were children or adolescents. The translocation t(1;19)(q23;p13) was the most common genetic abnormality identified (23.7% of cases), predominating in young patients. The translocation t(9;22)(q34;q11) was the next most common aberration (17.5%) occurring predominantly in adults 40 years of age, but also in 8.1% of children. Crude survival rates were overall poor (44.6% overall and 57.4% in patients 18 years of age). On survival analysis, older age, KMT2A-rearrangement and t(1;19) were independently associated with relapse-related death. The t(9;22) was not associated with mortality independently from age.Conclusion: B-ALL shows a distinct pattern of lymphoblastic leukaemia-associated chromosomal translocations in Johannesburg.

Regional variations in prevalence and severity of autosomal dominant polycystic kidney disease in the United States

Objectives To evaluate geographic variation in the prevalence of autosomal dominant polycystic kidney disease (ADPKD) in the US, including ADPKD at risk of rapid progression. Methods Claims data from the IBM MarketScan Commercial and Medicare Supplemental databases (01/16/2016–12/31/2017) were used to estimate the 2017 annual and 2016–2017 two-year prevalence of diagnosed ADPKD and ADPKD at risk of rapid progression in the US overall, and stratified by census regions and states. Risk of rapid progression was identified based on either: hypertension <35 years, hematuria <30 years, albuminuria, stage 2 chronic kidney disease (CKD) <30 years, stage 3 CKD <50 years, and stage 4/5 CKD or kidney transplant <55 years. Results Annual prevalence was estimated at 2.34 and two-year prevalence at 3.61 per 10,000 in the US. Across census regions, two-year prevalence per 10,000 was highest in the Northeast (4.14) and lowest in the West (3.35). Prevalence was significantly correlated with the proportion of individuals in urban areas (r = .34, one-sided p = .026). In 2017, 37.5% of patients were identified as being at risk for rapid progression, and this proportion was larger among patients in the South (42.1%, p < .001). Conclusion This estimate for ADPKD prevalence is consistent with previously reported national estimates, with regional variation suggesting that ADPKD might be under-diagnosed in rural areas with more limited access to care. More than one-third of ADPKD patients presented risk factors associated with rapid progression, highlighting the need for timely identification, as disease-modifying therapy may delay progression to end-stage renal disease.

MEAN ANNUAL TEMPERATURE IN VARIOUS REGION IS ASSOCIATED WITH THE PREVALENCE OF MASKED MORNING HYPERTENSION: THE J-HOP STUDY

Abstract Objective: Although previous studies have been reported home BP (HBP) is higher in cold region than that in warm region, regional variation in prevalence of masked hypertension remains unclear. We hypothesized that the prevalence of masked hypertension would be higher in cold region than that in warm region. Thus, we assessed the regional variation in the prevalence of masked hypertension using the dataset of the Japan Morning Home-Surge BP (J-HOP) study. Design and method: This is a cross-sectional, post-hoc analysis using the dataset of the J-HOP study, which recruited patients with a history of or risk factors of cardiovascular disease. Participants underwent consecutive 14-day HBP measurements (morning and evening). We divided participants into three regions, which were divided by mean annual temperature (&lt; 13 degree [Celsius], 13–15 degree, 15 degree &lt; ) in each participated facility. Masked morning or evening hypertension was defined as controlled office BP (systolic BP [SBP] &lt; 140 mmHg and diastolic BP [DBP] &lt; 90 mmHg) and uncontrolled morning or evening HBP (SBP &gt; = 135 or DBP &gt; = 85 mmHg). These criteria of BP levels were based on the Japanese guidelin on the management hypertension 2014 (JSH2014). Results: In the present study, 4268 participants (mean age, 64.9 ± 10.9 years; 46.9% male; 91.4% hypertensives) were divided 453, 1955, and 1860 partcipants into cold, moderate, and warm region, respectively. Office SBP was higher in cold region than others and morning home SBP was also higher in cold region than others. Whereas, evening home SBP had no significant differences between three regions. Moreover, in participants with normal (well-controlled) office BP, the prevalence of masked morning hypertension was higher in cold and moderate region than in warm region. However, the prevalence of masked evening hypertension had no significant differences between three regions. These relationships were also demonstrated after adjusted for traditional host factors in multivariate logistic regression analysis (All results are shown in Table). Conclusions: The present study demonstrated that the prevalence of masked morning hypertension was higher in colder regions than in warmer regions.

Genetic spectrum and predictors of mutations in four known genes in Asian Indian patients with growth hormone deficiency and orthotopic posterior pituitary: an emphasis on regional genetic diversity.

Regional variation in prevalence of genetic mutations in growth hormone deficiency (GHD) is known. Study phenotype and prevalence of mutations in GH1, GHRHR, POU1F1, PROP1 genes in GHD cohort. One hundred and two patients {Isolated GHD (IGHD): 79; combined pituitary hormone deficiency (CPHD): 23} with orthotopic posterior pituitary were included. Auxologic, hormonal and radiological details were studied. All four genes were analysed in IGHD patients. POU1F1 and PROP1 were studied in CPHD patients. Of 102, 19.6% were familial cases. Height SDS, mean (SD) was - 5.14 (1.63). Peak GH, median (range) was 0.47ng/ml (0-6.59), 72.5% patients had anterior pituitary hypoplasia (APH). Twenty mutations (novel: 11) were found in 43.1% patients (n = 44, IGHD-36, CPHD-8). GHRHR mutations (n = 32, p.Glu72* = 24) were more common than GH1 mutations (n = 4) in IGHD cohort. POU1F1 mutations (n = 6) were more common than PROP1 mutations (n = 2) in CPHD cohort. With few exceptions, this prevalence pattern is contrary to most studies in world-literature. No patients with peak GH > 4ng/ml had mutations, signifying it as negative predictor. While many parameters were significant on univariate analysis, only positive family history and lower median peak GH levels were significant predictors of mutations on multivariate analysis in IGHD patients. At variance with world literature, we found reverse predominance of GHRHR over GH1 mutations, POU1F1 over PROP1 mutations and predominance of GHRHR p.Glu72* mutations thus re-affirming the regional diversity in GHD genetics. We report positive and negative predictors of mutations in GHD.

An Epidemiology of Premarital Sexual Behaviour in India: Exploring Gender Differences

This article analyzes the social context of increasing premarital sex in India in a gender perspective, which affects the overall contexts, patterns and the characteristics of premarital sexual behaviour. The study has been conducted on data collected from 169,814 unmarried women and 40,003 unmarried men, a part of the Indian Demographic Health Survey (DHS), 2015–2016. Gender differences in premarital sex were pronounced, where unmarried men were five times more likely to have premarital sex (16%) as compared to unmarried women (3%). Cox regression portrays that both men and women at younger ages were significantly more likely to initiate premarital sex. Muslim men were significantly more likely (HR = 1.16 times) to have premarital sex at younger ages. Regional variations in the prevalence of premarital sex are pronounced. Findings reveal that unmarried women with higher education, residing in urban areas and who belong to richest wealth quintile and exposed to regular mass media were more likely to have multiple sexual partners in premarital sex. There is a striking regional variation in the low prevalence of condom use in the premarital sex reported by unmarried men as well as women. In fact, unmarried men were more likely to use condom in their first as well as last premarital sexual encounter than their women counterparts. Findings suggest strengthening the empowerment of youth, especially women, through enhancing their reproductive and sexual rights education and promoting safe sexual behaviour in premarital sexual encounters.

Evidence of transovarial transmission of Chikungunya and Dengue viruses in field-caught mosquitoes in Kenya.

Arboviruses are among the most important emerging pathogens due to their increasing public health impact. In Kenya, continued population growth and associated urbanization are conducive to vector spread in both urban and rural environments, yet mechanisms of viral amplification in vector populations is often overlooked when assessing risks for outbreaks. Thus, the characterization of local arbovirus circulation in mosquito populations is imperative to better inform risk assessments and vector control practices. Aedes species mosquitoes were captured at varying stages of their life cycle during different seasons between January 2014 and May 2016 at four distinct sites in Kenya, and tested for chikungunya (CHIKV), dengue (DENV) and Zika (ZIKV) viruses by RT-PCR. CHIKV was detected in 45 (5.9%) and DENV in 3 (0.4%) mosquito pools. No ZIKV was detected. Significant regional variation in prevalence was observed, with greater frequency of CHIKV on the coast. DENV was detected exclusively on the coast. Both viruses were detected in immature mosquitoes of both sexes, providing evidence of transovarial transmission of these arboviruses in local mosquitoes. This phenomenon may be driving underlying viral maintenance that may largely contribute to periodic re-emergence among humans in Kenya.

GEOGRAPHIC AND INDIVIDUAL DETERMINANTS OF IMPORTANT AMPHIBIAN PATHOGENS IN HELLBENDERS (CRYPTOBRANCHUS ALLEGANIENSIS) IN TENNESSEE AND ARKANSAS, USA.

Wildlife diseases are a major threat for species conservation and there is a growing need to implement disease surveillance programs to protect species of concern. Globally, amphibian populations have suffered considerable losses from disease, particularly from chytrid fungi (Batrachochytrium dendrobatidis [Bd] and Batrachochytrium salamandrivorans [Bsal]) and ranavirus. Hellbenders (Cryptobranchus alleganiensis) are large riverine salamanders historically found throughout several watersheds of the eastern and midwestern US. Populations of both subspecies (Ozark hellbender, Cryptobranchus alleganiensis bishopi; eastern hellbender, Cryptobranchus alleganiensis alleganiensis) have experienced precipitous declines over at least the past five decades, and emerging pathogens are hypothesized to play a role. We surveyed Ozark hellbender populations in Arkansas (AR) and eastern hellbender populations in Middle Tennessee (MTN) and East Tennessee (ETN) for both chytrid fungi and ranavirus from swabs and tail tissue, respectively, from 2011 to 2017. Overall, we detected Bd on hellbenders from nine out of 15 rivers, with total prevalence of 26.7% (54/ 202) that varied regionally (AR: 33%, 28/86; MTN: 11%, 4/36; ETN: 28%, 22/80). Ranavirus prevalence (9.0%, 18/200) was comparatively lower than Bd, with less regional variation in prevalence (AR: 6%, 5/ 85; MTN: 11%, 4/36; ETN: 10%, 8/79). We did not detect Bsal in any hellbender populations. We detected a significant negative correlation between body condition score and probability of ranavirus infection (β=-0.13, SE=0.06, 95% confidence interval: -0.24, -0.02). Evaluation of infection load of positive individuals revealed different trends than prevalence alone for both ranavirus and Bd, with MTN having a significantly greater average ranaviral load than both other regions. We documented a variety of lesions that likely have multiple etiologies on hellbenders located within all geographic regions. Our data represent a multiyear pathogen dataset across several regions of C. alleganiensis, and we emphasize the need for continued pathogen surveillance.

1479-P: Regional Variations in Chronic Kidney Disease Prevalence among Patients with or without Type 2 Diabetes (RADAR) in the U.S.

Introduction: Type 2 diabetes (T2D) represents the leading cause of Chronic Kidney Disease (CKD) worldwide. While variation in T2D prevalence in the U.S. is well established, regional variation in the prevalence of CKD in patients with or without (w/o) T2D is less well characterized and may inform targeted implementation of risk-reducing interventions. Objective: We explored regional variations in the prevalence of CKD in patients with or w/o T2D in the U.S. Method: Data from January 1, 2013 through December 31, 2017 from an employer-based claims database (MarketScan) was used for this analysis. Continuously enrolled patients aged ≥18 years diagnosed with CKD with or w/o T2D were identified using International Classification of Disease diagnosis codes. We estimated overall CKD, CKD+T2D, and CKD w/o T2D prevalence for each year from 2013 to 2017. Geo-mapping was used to visualize the prevalence of CKD. Univariate and differential local indicators for spatial analyses (LISA) were performed to describe the geographic differences of CKD prevalence. Results: The overall prevalence of CKD doubled from 1.50% in 2013 to 3.11% in 2017. Within the CKD population, 46.3% had T2D in 2017. The prevalence of CKD+T2D increased from 0.70% in 2013 to 1.44% in 2017. From 2013 to 2017, low-low clusters from univariate LISA were consistently observed in the Northwest regions (e.g., MT, WY) (P&amp;lt;0.05), indicating the consistently low prevalence of CKD in these areas. High-high clusters from differential LISA, which implied the clusters of increasing CKD prevalence, were found in the Southeast regions (e.g., FL, MS) (P&amp;lt;0.05). Conclusion: This study provides real-world evidence of regional variations in CKD prevalence in the U.S. Additionally, this study identified lower CKD prevalence than previously cited in the literature, which may indicate major under-coding in the employer-based claims database. Further characterization of CKD patients with or w/o T2D could help understand these variations. Disclosure X. Feng: None. R. Farej: Employee; Self; Bayer U.S. F. Xia: None. A.S. Gaiser: None. S. Kong: None. J. Elliott: None. S. Lindemann: None. R. Singh: None.

The epidemiology of hepatitis delta virus infection in Cameroon

ObjectiveTo investigate the distribution and risk factors of hepatitis delta virus (HDV) infection in Cameroon.DesignWe tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-HDV antibody 14 150 samples...

Risk factors of acute malnutrition among children aged 6\u201359\u2009months enrolled in a community-based programme in Kurigram, Bangladesh: a mixed-method matched case-control study

BackgroundRisk factors of acute malnutrition in Bangladesh are well documented. However, due to regional variations in prevalence of acute malnutrition, it is important to explore the risk factors specific to the region, for designing and implementing public health interventions.MethodsA mixed-method matched case-control study was conducted in the Kurigram district of Bangladesh. Community perspectives on causes of acute malnutrition were collected from 75 purposively selected caregivers through interviews, focus group discussions and informal group discussions. The data was analysed manually by coding and sub-coding according to different themes. Caregivers of 52 malnourished and 95 well-nourished children matched in age group and sex with the malnourished children, were interviewed using a structured questionnaire. The conditional logistic regression analysis was performed to identify the risk factors of acute malnutrition.ResultsCaregivers perceived inappropriate feeding practice as a major cause of acute malnutrition whereas birth order (first child OR 0.3, 95% CI 0.09, 0.96), number of family members (OR 1.30, 95% CI 1.02, 1.65), illness in the last 2 weeks (OR 3.08, 95% CI 1.13, 8.42) and access to hygienic latrine (OR 0.25, 95% CI 0.07, 0.82) were also associated with acute malnutrition among children under five in Kurigram.ConclusionsCommunity awareness on infant feeding practices and family planning, management of childhood illness and access to hygienic latrine facilities should be prioritised to prevent acute malnutrition in the northern districts.