Prevalence of individual brain and eye defects potentially related to Zika virus in pregnancy in 22 U.S. states and territories, January 2016 - June 2017

During the Centers for Disease Control and Prevention’s Zika Virus Response, birth defects surveillance programs adapted to monitor birth defects potentially related to Zika virus (ZIKV) infection during pregnancy. Pregnancy outcomes occurring during January 2016-June 2017 in 22 U.S. states and territories were used to estimate the prevalence of those brain and eye defects potentially related to ZIKV. Jurisdictions were divided into three groups: areas with widespread ZIKV transmission, areas with limited local ZIKV transmission, and areas without local ZIKV transmission. Prevalence estimates for selected brain and eye defects and microcephaly per 10,000 live births were estimated. Prevalence ratios (PRs) and 95% confidence intervals (CIs) were estimated using Poisson regression for areas with widespread and limited ZIKV transmission compared to areas without local ZIKV transmission. Defects with significantly higher prevalence in areas of widespread transmission were pooled, and PRs were calculated by quarter, comparing subsequent quarters to the first quarter (January – March 2016). Nine defects had significantly higher prevalence in areas of widespread transmission. The highest PRs were seen in intracranial calcifications (PR=12.6, 95% CI [7.4, 21.3]), chorioretinal abnormalities (12.5 [7.1, 22.3]), brainstem abnormalities (9.3, [4.7, 18.4]), and cerebral/cortical atrophy (6.7, [4.2, 10.8]). The PR of the nine pooled defects was significantly higher in three quarters in areas with widespread transmission. The largest difference in prevalence was observed for defects consistently reported in infants with congenital ZIKV infection. Birth defects surveillance programs could consider monitoring a subset of birth defects potentially related to ZIKV in pregnancy.

Multimorbidity Among Migrant and Non-Migrant Ghanaians: The RODAM Study

Objectives: Multimorbidity is a growing public health concern due to the increasing burden of non-communicable diseases, yet information about multimorbidity in low- and middle-income countries and migrant populations is scarce. We aimed to investigate the distribution and patterns of multimorbidity in rural and urban areas in Ghana and Ghanaian migrants in Europe.Methods: The RODAM cross-sectional study included 4,833 participants. Multimorbidity was defined as presence of multiple non-communicable chronic conditions. Patterns were determined from frequent combination of conditions. Prevalence ratios were estimated by logistic regression.Results: Prevalence of multimorbidity was higher in women and in urban Ghana and Europe. We observed a cardiometabolic pattern in all sites as well as circulatory-musculoskeletal and metabolic-musculoskeletal combinations in Ghana. Multimorbidity prevalence ratios were higher in Europe (men 1.47, 95% CI 1.34–1.59, women 1.18, 1.10–1.26) and urban Ghana (men 1.46, 1.31–1.59, women 1.27, 1.19–1.34).Conclusion: Distribution and patterns of multimorbidity differed by sex and site. With a higher burden of multimorbidity in urban areas, prevention strategies should focus on forestalling its increase in rapidly growing rural areas.

A Multilevel Study of Socio-economic Inequalities in Self-reported Oral and General Health in South-east Norway

This study assesses the association between socioeconomic determinants and self-reported health using data from a regional Norwegian health survey. A total of 9,068 participants 25+ were included. Survey data were linked to registry data on education and personal income. Self-reported oral health and general health were separately assessed and categorized into ‘good’ and ‘poor’. The exposures were educational level, personal income, and economic security. Prevalence ratios (PRs) were computed to assess the associations between socioeconomic determinants and self-reported health using multilevel Poisson regression. Participants with low education or income had poorer oral and general health than those with more education or higher income. Comparing the highest education level versus the lowest, adjusted PRs for poor oral and general health were 1.44 (95%CI 1.26-1.65) and 1.53 (95%CI 1.35-1.74). Correspondingly, with the highest income quintile versus the lowest, estimates were 1.64 (95%CI 1.39-1.94) and 2.34 (95%CI 1.97-2.79) for oral and general health. Lack of economic security was also significantly associated with poor self-reported oral and general health. Positive linear trends between levels of education and income were documented for both outcomes (P-linear trends <0.001), including a pattern of socioeconomic gradients, both for oral and general health.

Association between Iron Supplementation and the Presence of Diarrhea in Peruvian Children Aged 6–59 Months: Analysis of the Database of the Demographic Health Survey in Peru (DHS, Peru), Years 2009–2019

Introduction: According to the World Health Organization (WHO), anemia is a severe public health problem when the prevalence is ≥ 40%. In 2019, in Peru, 40.1% of children (age 6 to 35 months) are diagnosed as anemic. This is a concern since, despite the efforts of the governments to reduce the prevalence, the problem has stagnated since 2011. The treatment applied to deal with anemia is iron supplementation. Although iron is essential for cell function, an excess can produce adverse responses, such as gut inflammation affecting microbiota and resulting in diarrheic episodes. Objective: To determine the association between diarrhea and iron supplementation in children with and without anemia, controlling for different socio-demographic variables. Design: We conducted via logistic regression to obtain diarrhea prevalence ratios, adjusted by age, sex, geographic region, water and sanitation service, and rurality. The survey asked for recent episodes of diarrhea during the last 7 days; similarly, after the consumption of iron supplements during the last 12 months before the survey. Setting: Peru Subjects: The Demographic and Health Survey (DHS) is conducted annually at home among 14,202 children on average (2009 – 2019). Results: Iron supplementation in the last seven days (PR=1.09) or the last twelve months (PR=1.19) (p<0.0001) was associated with an increased risk of diarrhea. The same association was observed between iron supplementation and the presence of anemia. Conclusions: Iron supplementation is associated with diarrhea and over-use in children should be avoided.

Loneliness Among US Adults During the Early Phase of the COVID-19 Pandemic: Findings From the COVID-19 Coping Study

We aimed to estimate the prevalence of loneliness and identify the key sociodemographic, employment, living, and health-related risk factors for loneliness among middle-aged and older adults during the early COVID-19 pandemic in the US, when shelter-in-place and social distancing restrictions were in place for much of the country. Data were collected from online questionnaires in the COVID-19 Coping Study, a national study of 6,938 US adults aged 55-110 years, from April 2nd through May 31st, 2020. We estimated the population-weighted prevalence of loneliness (scores of ≥6/9 on the 3-item UCLA Loneliness Scale), overall and according to sociodemographic, employment, living, and health-related factors. We used population-weighted modified Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the associations between these factors and loneliness, adjusted for age, sex, race, ethnicity, and education. Overall, 29.5% (95% CI: 27.9%, 31.3%) of US adults aged 55-110 were considered high in loneliness in April and May, 2020. In population-weighted, adjusted models, loneliness was most frequent among those with depression, those who were divorced or separated, those who lived alone, those diagnosed with multiple comorbid conditions, and individuals who were unemployed prior to the pandemic. In conclusion, we identified subpopulations of middle-aged and older US adults that were highly affected by loneliness during a period when COVID-19 shelter-in-place orders were in place across most of the country. These insights may inform the allocation of recourses to mitigate loneliness during times of restricted activity.

Major Discrimination, Race-Ethnicity, and Inflammation Among Older Adults

This study examines the relationship between self-reported instances of major discrimination and inflammation among older adults, and explores whether this relationship varies in accordance with race/ethnicity. Data from 2006/2008 Health and Retirement Study was used to collect measures of self-reported instances of major discrimination and high-risk C-reactive protein (CRP), which was assayed from blood samples. Modified Poisson regression with robust standard errors was applied to estimate the prevalence ratios of self-reported instances of major discrimination, as it relates to high-risk CRP (CRP ≥ 22 kg/m2), and test whether this relationship varies by race/ethnicity. Respondents who experienced any instances of major discrimination had a higher likelihood of high-risk CRP (prevalence ratio [PR]: 1.14, 95% confidence interval [CI] = 1.07–1.22) than those who did not report experiencing any instances of major discrimination. This relationship was weaker for blacks than whites (PR: 0.81, 95% CI = 0.69–0.95).

Metabolic Syndrome in Patients of a Psychosocial Care Center in Brazil: A Cross-Sectional Study

Background: Metabolic syndrome (MS) is associated with a greater risk of morbimortality. Ob-jective: To estimate the prevalence of Metabolic Syndrome (MS) and associated factors in patients of a Psychosocial Care Center (CAPS) in the city of Salvador, state of Bahia, Brazil. Method: Cross-sectional study set at CAPS in the city of Salvador-Bahia, between August 2019 and February 2020. MS was evaluated according to the National Cholesterol Education Program's Adult Treatment Panel III. In addition to descriptive statistics, gross and adjusted prevalence ratios were described. Results: MS was found in 100 (35.2%) individuals, 116 (40.9%) were obese and 165 (58.1%) had increased waist circumference. Polypharmacy was identified in 63 (22.3%) patients and 243 (85.9%) used antipsychotics. In the gross evaluation, the female (PR = 1.88; 95% CI: 1.35-2.63) and the use of antidepressants (PR = 1.41; 95%CI: 1.05-1.88) were associated with MS. After logistic re-gression, depression (PR = 1.86; 95%CI: 1.38-2.51), acanthosis (PR = 1.50; 95%CI: 1.18 - 1.90), use of antipsychotics (PR = 1.88; 95%CI: 1.13 - 2.75) and the hypertriglyceremic waist (PR = 3.33; 95%CI: 2.48- 4.46) were associated with MS. Conclusion: The prevalence of MS alerts to multimorbidity among individuals with mental disorders and the need for clinical screening.

Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study

Background In the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, consultations and pregnancy monitoring examinations had to be reorganised urgently. In addition, women themselves may have postponed or cancelled their medical monitoring for organisational reasons, for fear of contracting the disease caused by SARS-CoV-2 (COVID-19) or for other reasons of their own. Delayed care can have deleterious consequences for both the mother and the child. Our objective was therefore to study the impact of the SARS-CoV-2 pandemic and the first lockdown in France on voluntary changes by pregnant women in the medical monitoring of their pregnancy and the associated factors. Methods A cross-sectional study was conducted in July 2020 using a web-questionnaire completed by 500 adult (> 18 years old) pregnant women during the first French lockdown (March–May 2020). A robust variance Poisson regression model was used to estimate adjusted prevalence ratios (aPRs). Results Almost one women of five (23.4%) reported having voluntarily postponed or foregone at least one consultation or pregnancy check-up during the lockdown. Women who were professionally inactive (aPR = 1.98, CI95%[1.24–3.16]), who had experienced serious disputes or violence during the lockdown (1.47, [1.00–2.16]), who felt they received little or no support (1.71, [1.07–2.71]), and those who changed health professionals during the lockdown (1.57, [1.04–2.36]) were all more likely to have voluntarily changed their pregnancy monitoring. Higher level of worry about the pandemic was associated with a lower probability of voluntarily changing pregnancy monitoring (0.66, [0.46–0.96]). Conclusions Our results can guide prevention and support policies for pregnant women in the current and future pandemics.

Socio-demographic Determinants of Low Physical Activity in Peruvian Adults: Results of a Population-based Survey Performed in 2017-2018

Objectives: The objective of this study was to determine the prevalence of low physical activity (PA) in Peruvian adults and to identify associated factors.Methods: An analytical study was performed using data from the 2017-2018 Nutritional Food Surveillance by Life Stages survey. The outcome variable was low PA (yes or no), assessed using the International Physical Activity Questionnaire-short form. Prevalence ratios were estimated as a measure of association.Results: Among the 1045 persons included in the analysis, the age-standardized prevalence of low PA was 61.9%. The adjusted model showed that being female and migrating from a rural to an urban area in the last 5 years were associated with a higher probability of having low PA than males and individuals who had not migrated, while residing in rural highlands and jungle areas was associated with a reduced probability of having low PA compared to people residing in other geographic domains.Conclusions: Being a female and migration from a rural to an urban area in the last 5 years were associated with a higher likelihood of having low PA. Therefore, promotion and prevention strategies related to PA are required, especially in the female and migrant populations.

Having children is associated with a higher prevalence of COVID-19 among young adults in Kuwait

Objectives: The role of children in the transmission of the coronavirus disease 2019 (COVID-19) remains unclear. We investigated whether having children is associated with self-reported COVID-19 among adults. Subjects and Methods: A cross-sectional study enrolled adults (n=2368; aged ≥21 years). Prior COVID-19 diagnosis and having children were self-reported. Associations were assessed using Poisson regression and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated. Results: Overall, 4.8% (114/2355) of the participants reported having had COVID-19. In the total sample, having children showed a trend for association with having had COVID-19 (aPR: 1.46, 95% CI: 0.99-2.14). Among participants aged 21-29 years, having children was associated with an increased prevalence of COVID-19 (aPR: 2.50, 95% CI: 1.21-5.20). Such an association was not detected in adults aged ≥30 years. Conclusions: Our epidemiological findings highlight the possible role of children in spreading COVID-19. Hence, preventive measures should consider the role of children.