Surveillance and epidemiology of SARS-CoV-2 viral variants in the United States, May-October 2021 (Preprint)

UNSTRUCTURED Background: Genomic sequencing of SARS-CoV-2 positive specimens has been critical in detecting and tracking variants of concern. Methods: We analyzed a recent cohort of SARS-CoV-2-positive specimens collected from patients in over 5,000 testing locations across the United States. These data were combined with an online pre-screening questionnaire on symptoms, exposures and vaccination status to examine epidemiological trends related to virulence, transmissibility, and vaccine effectiveness. Results: Between May and October 2021, 177,253 patient specimens were sequenced and approximately 400 different SARS-CoV-2 lineages identified. Within this cohort, 152,373 (86.0%) were aged 16 and older, and the percent of these patients that were fully vaccinated increased from 4.5% in May to 42.3% in October. Although positivity rates of fully vaccinated patients increased, unvaccinated patients were 30.4% (95% CI 26.5-34.3%) more likely to report shortness of breath and 34.0% (95% CI 32.1-35.9%) more likely to report fever, shaking, or chills. Conclusions: Our nationally representative database of patient-reported measures and lineage data from SARS-CoV-2 specimens provides useful data to track emerging trends and lineages of concern.

Influence of maternal excess weight before pregnancy on breastfeeding and weaning: pooled analyses of four population-based cohorts born between 1982-2015

Purpose: To investigate the associations of maternal excess weight before pregnancy with (1) weaning at age 3mo, (2) duration of exclusive breastfeeding at age 6mo, (3) duration of any breastfeeding at age 12mo; and (4) to compare the magnitude of these associations over four decades. Methods: Data were from participants in the Pelotas (Brazil) Birth Cohorts born in 1982 (N=5,334), 1993 (N=1,442), 2004 (N=4,092) and 2015 (N=4,102). Maternal pre-pregnancy weight was collected after the delivery and breastfeeding status was assessed when children were three and 12 months old. Results: Only in the most recent cohort (2015), women with excess weight [body mass index (BMI) ≥ 25 kg/m2) before pregnancy had higher risk of discontinuing exclusive breastfeeding within the first six months post-partum than women with normal weight [HR= 1.22 (95%CI 1.15; 1.30)]. Duration of any type of breastfeeding until 12 months of age was not affected by pre-pregnancy weight. Conclusion: Excess weight before pregnancy is associated with exclusive breastfeeding only in the most recent birth cohort coinciding with increases in weight excess and breastfeeding over time.

Incidence of collagenous colitis in NHS Lothian: a population-based study

ObjectiveIncreases in incidence of collagenous colitis (CC) have been documented across Europe; however, previous data from NHS Lothian (1998–2003) demonstrated this to be a low-prevalence area. We aimed to assess incidence of CC in NHS Lothian over time by comparing a more recent cohort (2013–2018) with our existing cohort.MethodsAll histologically confirmed diagnoses of CC between 2013 and 2018 were obtained from the NHS Lothian colorectal pathology department (Western General Hospital, Edinburgh). Case record review was performed to obtain relevant demographic and clinical data. Data were also collected regarding the availability of colonoscopy in NHS Lothian.Results224 cases of CC were diagnosed between 2013 and 2018, compared with 25 between 1998 and 2003. Mean annual incidence rose from 0.5/100 000 population to 4.3/100 000 population. Incidence in females ≥60 years old rose from 2.3/100 000 population to 22.4/100 000 population (p<0.001). The total number of colonoscopies performed increased by 179.1% from 15 262 (1998–2003) to 42 600 (2013–2018), with the number of CC cases per 1000 colonoscopies performed rising from 1.7 to 5.3 (p<0.001).ConclusionWe describe the increasing incidence of CC in Southeast Scotland, with temporal trends comparable to other European countries. The increase is particularly marked in older females and parallels increasing numbers of colonoscopies being performed.

Chronic Allograft Injury

With the incremental improvements in long-term kidney transplant survival, there is renewed focus on what causes failure of the transplanted allograft. Over the past decade, our understanding of the injuries that lead to loss of graft function over time has evolved. Chronic allograft injury includes both immune-mediated and nonimmune-mediated injuries, which may involve the organ donor, the recipient, or both. The targets of injury include the kidney tubular epithelium, the endothelium, and the glomerulus. As a response to injury, there are the expected tissue remodeling and repair processes. However, if inflammation persists, which is not uncommon in the transplant setting, the resulting maladaptive response is matrix deposition and/or fibrosis. This ultimately leads to declining graft function and, finally, failure. With our advancing knowledge of the multiple etiologies and mechanisms, enhanced by more recent cohort studies in humans, there is an opportunity to identify those at greater risk to initiate new strategies to ameliorate the process. Although the most recent studies focus on immune-mediated injuries, there is a critical need to identify both markers of injury and mechanisms of injury. In this review, we highlight the findings of recent studies, highlight the potential therapeutic targets, and identify the continued unmet need for understanding the mechanisms of late graft failure.

Proportion and reasons for loss to follow-up in a cohort study of people who inject drugs to measure HIV and HCV incidence in Kerman, Iran

Background Understanding the reasons for loss to follow-up (LTFU) in cohort studies, especially among marginalized groups such as people who inject drugs (PWID), is needed to strengthen the rigor of efficacy trials for prevention and treatment interventions. We assessed the proportion and reasons for loss to follow-up in a recent cohort of PWID enrolled in the southeast of Iran. Methods Using respondent-driven sampling, we recruited 98 PWID age 18 years or older who reported injecting drugs in the past 6 months, and were negative for HIV and HCV at initial screening. Participants were followed at 6 week intervals, alternating a short six-week visit and long 12-week or quarterly visit to measure incidence of HIV and HCV. Methods to enhance retention included incentives for completing each visit, tracking people who missed the scheduled visits through their peer referral networks, engaged outreach teams to explore hotspots and residences, and photos. LTFU was defined as participants who missed their quarterly visits for two or more weeks. Results Mean (SD) age of participants was 39.7 years (SD 9.6). Of 98 enrolled, 50 participants (51.0%) were LTFU by missed their scheduled quarterly visits for 2 weeks or more. For those whose reasons for LTFU could be defined (46.0%, 23 of 50), main reasons were: forgetting the date of visit (43.5%, 10 of 23), being incarcerated (39.1%, 9 of 23), and moving out of the city (17.4%, 4 of 23). Conclusion This study highlighted the difficulty in retaining PWID in longitudinal studies. Despite having several retention strategies in place, over half of PWID were LTFU. The LTFU might be reduced by setting up more effective reminder systems, working closely with security systems, and online means to reach those who move outside the study area.

Detecting Potentially Ineffective Care in Critically Ill Patients in a Community Hospital: Assessing Sustained Predictive Value after Two Decades

Background: Eighteen years ago, we derived a formula to predict 100-day post-discharge mortality, utilizing the Acute Physiology and Chronic Health Evaluation III (APACHE III) data. This study was designed to reassess this formula when applied to a new cohort of patients, utilizing the updated predictive hospital mortality equations derived from APACHE IV.Methods: Compared with the 1995‒1997 cohort in our original study, this study included a cohort of intensive care unit patients from 2012‒2017, with similar demographics. Both cohorts included patients >18 years old admitted to and surviving at least five days of intensive care in the Sarasota Memorial Hospital in Sarasota, Florida, USA. Results: In the recent cohort, the formula exhibited a specificity of 99.7%, sensitivity of 17.8%, false positive rate of 0.3%, and positive predictive value of 92.6%; applied to the original cohort, the formula exhibited values of 98.7%, 33.8%, 1.3%, and 93.3%, respectively. There was no statistical difference between the two databases, except in sensitivity. Conclusions: Potentially ineffective care can be predicted with nearly the same specificity and predictive value using the formula developed in the 2002 study. If these results are reproducible at other institutions, they could assist in patient/family and palliative care discussions.

Inequality at the top. The gender wage gap among the Italian educational elites

Women notoriously get lower wages compared to men. Does a gender wage gap exist also at the top of the educational distribution? Based on population data on two recent cohort of PhD graduates in Italy, we found women’s monthly wages are on average 16% lower than men’s’ after 5–6 years on the labor market. The gender wage gap is even stronger at the very bottom and the top of the wage distribution, around 22% and 19% respectively. Educational pathways before and during PhD studies, occupational characteristics, and the family situation explain almost half of the average women’s penalty and working hours alone one-fifth of it. However, the strongest penalties at the bottom and the top of the wage distribution remain largely unexplained.

Factors associated with syphilis seroprevalence in women with and at-risk for HIV infection in the Women’s Interagency HIV Study (1994–2015)

ObjectiveSyphilis rates among women in the USA more than doubled between 2014 and 2018. We sought to identify correlates of syphilis among women enrolled in the Women’s Interagency HIV Study (WIHS) to inform targeted interventions.MethodsThe retrospective cross-sectional analysis of secondary data included women with HIV or at-risk of HIV who enrolled in the multisite US WIHS cohort between 1994 and 2015. Syphilis screening was performed at baseline. Infection was defined serologically by a positive rapid plasma reagin test with confirmatory treponemal antibodies. Sociodemographic and behavioural characteristics stratified by baseline syphilis status were compared for women enrolled during early (1994–2002) and recent (2011–2015) years. Multivariable binomial modelling with backward selection (p>0.2 for removal) was used to model correlates of syphilis.ResultsThe study included 3692 women in the early cohort and 1182 women in the recent cohort. Syphilis prevalence at enrolment was 7.5% and 3.7% in each cohort, respectively (p<0.01). In adjusted models for the early cohort, factors associated with syphilis included age, black race, low income, hepatitis C seropositivity, drug use, HIV infection and >100 lifetime sex partners (all p<0.05). In the recent cohort, age (adjusted prevalence OR (aPOR) 0.2, 95% CI 0.1 to 0.6 for 30–39 years; aPOR 0.5, 95% CI 0.2 to 1.0 for 40–49 years vs ≥50 years), hepatitis C seropositivity (aPOR 2.1, 95% CI 1.0 to 4.1) and problem alcohol use (aPOR 2.2, 95% CI 1.1 to 4.4) were associated with infection.ConclusionsSyphilis screening is critical for women with HIV and at-risk of HIV. Targeted prevention efforts should focus on women with hepatitis C and problem alcohol use.