Higher exhaled nitric oxide at 6 weeks of age is associated with less bronchiolitis and wheeze in the first 12 months of age

BackgroundNitric oxide in exhaled air (eNO) is used as a marker of type 2 immune response-induced airway inflammation. We aimed to investigate the association between eNO and bronchiolitis incidence and respiratory symptoms in infancy, and its correlation with eosinophil protein X (EPX).MethodsWe followed up infants at 6 weeks of age born to mothers with asthma in pregnancy and measured eNO during natural sleep using a rapid response chemiluminescense analyser (CLD88; EcoMedics), collecting at least 100 breaths, interpolated for an expiratory flow of 50 mL/s. EPX normalised to creatinine was measured in urine samples (uEPX/c). A standardised questionnaire was used to measure symptoms in first year of life. Associations were investigated using multiple linear regression and robust Poisson regression models.ResultseNO levels were obtained in 184 infants, of whom 125/184 (68%) had 12 months questionnaire data available and 51/184 (28%) had uEPX/c measured. Higher eNO was associated with less respiratory symptoms during the first 6 weeks of life (n=184, ß-coefficient: –0.49, 95% CI –0.95 to –0.04, p=0.035). eNO was negatively associated with uEPX/c (ß-coefficient: –0.004, 95% CI –0.008 to –0.001, p=0.021). Risk incidence of bronchiolitis, wheeze, cold or influenza illness and short-acting beta-agonist use significantly decreased by 18%–24% for every unit increase in eNO ppb.ConclusionHigher eNO levels at 6 weeks of age may be a surrogate for an altered immune response that is associated with less respiratory symptoms in the first year of life.

99. Presence of Chronic Diseases and Compliance with Québec Provincial Guidelines for Outpatient Antibiotic Prescription, Québec, Canada, 2010-2017

Background In Québec primary care, antimicrobial use is higher in patients with chronic diseases, but it is unclear whether this utilization may be reduced. We aimed to measure the proportion of compliant antimicrobial prescriptions according to the provincial guidelines for the treatment of common respiratory and urinary infections and measure variations in this proportion with certain chronic diseases. Methods Antimicrobial dispensing covered by the public drug insurance plan between April 2010 and March 2017, delivered within 2 days of an outpatient consultation for an infection was included. Infections targeted by provincial guidelines were studied: otitis media, pharyngitis, pneumonia, sinusitis, bronchitis and chronic obstructive pulmonary disease exacerbations, cystitis, and acute pyelonephritis. The proportion of prescriptions compliant with guidelines (right antimicrobial for children, and right antimicrobial and dosage for adults) was computed by age group (children or adults) and per category of chronic disease (respiratory, cardiovascular, diabetes, mental disorder, none of previous). For each infection and age group, multivariate robust Poisson regression was used to measure the impact of categories of chronic diseases on proportions of prescriptions compliant with guidelines. Results Between 14 677 and 312 786 prescriptions were included, for each infection. Compliance to guidelines was above 87% in children and was significantly lower (≤ 3% bellow) in children with asthma. In adults, the choice of agent was compliant for at least 73% of prescriptions, except for cases of pharyngitis (between 53% and 61%). Accounting for dosage led to lower proportions of compliance, which varied between 19% (cystitis with diabetes) and 77% (pyelonephritis with none of the studied chronic disease categories). Compliant prescriptions were 2,4% to 20,4% less frequent in the presence of chronic diseases (statistically significant). Conclusion Non-compliant prescriptions could still be appropriate, but their high frequency suggests there is room for improvement. Dosage seems particularly problematic. Additional support could be offered to clinicians for the prescription of antimicrobials to patients with chronic diseases. Disclosures All Authors: No reported disclosures

Prevalence and associated factors with sexual violence victimisation youth before, during and after the COVID-19 lockdown: a cross-sectional study in Spain

ObjectivesTo analyse the prevalence of sexual violence (SV) and associated factors in Spanish young adults in the last year and before, during and after the COVID-19 lockdown.DesignCross-sectional study based on the online ‘SV in Young People Survey’ (2020).SettingNon-institutionalised population residing in Spain.Participants2515 men and women aged 18–35 years old. The participants were obtained from a probability based, online closed panel of adults aged 16 or older that is representative of the non-institutionalised population. The sample designed includes quotas by sex, age, region and country of origin.Outcomes measures and analysesSV victimisation by sociodemographics, sexual attraction and couple-related characteristics during the past year and before, during and after the COVID-19 lockdown (March–June 2020). Prevalence ratios were calculated using robust Poisson regression models.ResultsIn Spain, 8.5% of young people experienced SV during the past year. The greatest prevalence was observed in women with bisexual attraction (17.5%) and in men with homosexual attraction (14.2%). During the COVID-19 lockdown, the prevalence of SV victimisation was lower (1.9%), but unwanted intercourses increased, affecting 64.4% of those exposed to SV during the period. People with homosexual or bisexual attraction were more likely to experience SV in all of the studied periods (PRbefore: 2.01; p<0.001; PRduring: 2.63 p=0.002; PRafter: 2.67; p<0.001). Women were more likely than men to experience SV prior to the lockdown, while no cohabitation increased the likelihood to experience SV after this periodConclusionsSV victimisation in Spanish youth is high. During COVID-19, there were changes in the magnitude of factors associated with SV. It seems that SV events decreased in people who did not live with their partners, but unwanted intercourses increased. The development of prevention strategies to address SV in youth should take into account social inequalities by sex, sexual orientation and origin.

Prognostic Value of Baseline Biochemical Parameters Among Severe COVID-19 Patients Admitted to an Intensive Care Unit of a Tertiary Hospital in South Africa.

BackgroundData on biochemical markers and their association with mortality rates observed in patients with severe COVID-19 disease admitted to Intensive Care Units (ICUs) in sub-Saharan Africa are scanty. We performed an evaluation of baseline routine biochemical parameters as prognostic biomarkers in COVID-19 patients admitted to ICU. MethodsDemographic, clinical and laboratory data were collected prospectively on patients with PCR-confirmed COVID-19 admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality. ResultsA total of 82 patients [(median age 53.8 years (IQR: 46.4-59.7)] were enrolled, of whom 27 (33%) were male. The median duration of ICU stay was 10 days (IQR: 5-14); 54/82 (66% CFR) patients died. Baseline lactate dehydrogenase (LDH) (aRR: 1.002, 95%CI: 1.0004-1.004; P = 0.016) and N-terminal pro B-type natriuretic peptide (NTProBNP) (aRR: 1.0004, 95%CI: 1.0001-1.0007; P = 0.014) were both independent risk factors of a poor prognosis with optimal cut-off values of 449.5 U/L (sensitivity: 1; specificity: 0.43) and 551 pg/mL (sensitivity: 0.49; specificity: 0.86), respectively.ConclusionLDH and NTProBNP appear to be promising predictors of COVID-19 poor prognosis in the ICU. Larger sample size studies are required to confirm the validity of this combination of biomarkers.

Prevalence and Predictors of Food Insecurity among People Living with and without HIV in the African Cohort Study

Objective: We determined the prevalence and identified predictors of food insecurity in four African countries. Design: Cross-sectional analyses at study enrollment. Setting: From January 2013 to March 2020, people living with HIV (PLWH) and without HIV were enrolled at 12 clinics in Kenya, Uganda, Tanzania, and Nigeria. Participants: Participants reporting not having enough food to eat over the past 12 months or receiving <3 meals/day were defined as food insecure. Robust Poisson regression models were used to estimate unadjusted and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for predictors of food insecurity among all participants and separately among PLWH. Results: 1694/3496 participants (48.5%) reported food insecurity at enrollment, with no difference by HIV status. Food insecurity was more common among older participants (50+ years vs. 18-24 years aPR 1.35, 95% CI 1.15-1.59). Having 2-5 (aPR 1.14, 95% CI 1.01-1.30) or >5 dependents (aPR 1.17, 95% CI 1.02- 1.35), and residing in Kisumu West, Kenya (aPR 1.63, 95% CI 1.42-1.87) or Nigeria (aPR 1.20, 95% CI 1.01- 1.41) was associated with food insecurity. Residing in Tanzania (aPR 0.65, 95% CI 0.53-0.80) and increasing education (secondary/above education vs. none/some primary education aPR 0.73, 95% CI 0.66-0.81) was protective against food insecurity. ART-experienced PLWH were more likely to be food secure irrespective of viral load. Conclusion: Food insecurity was highly prevalent in our cohort though not significantly associated with HIV. Policies aimed at promoting education, elderly care, ART access in PLWH, and financial independence could potentially improve food security in Africa.

Factors associated with testing for HIV and hepatitis C among behaviorally vulnerable men in Germany: a cross-sectional analysis upon enrollment into an observational cohort

Background HIV and hepatitis C virus (HCV) have shared routes of transmission among men who have sex with men (MSM). Routine testing facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We evaluated factors associated with HIV and HCV testing in a behaviorally vulnerable cohort of predominantly MSM. Methods From June 2018 through June 2019, the BRAHMS study enrolled adults at ten German outpatient clinics that serve gender and sexual minority populations. Participants completed behavioral questionnaires that captured prior experience with HIV and HCV testing. Multivariable robust Poisson regression was used to evaluate factors potentially associated with testing in the previous 6 months. Results Among 1017 participants with median age 33 (interquartile range 28–39) years, 1001 (98.4%) reported any lifetime history of HIV testing and 787 (77.4%) reported any HCV testing, including 16 (1.6%) known to be living with HCV. Testing within the last 6 months was reported by 921 (90.6%) and 513 (50.4%) for HIV and HCV, respectively. Recent HIV testing was more common among participants with higher education level and recent HCV testing. Recent HCV testing was more common among participants with non-cisgender identity, lifetime history of illicit drug use, hepatitis B immunity or infection, and recent HIV testing. Conclusion Prior testing for HIV was common in this cohort, but interventions are needed to improve HCV risk stratification and access to testing. HIV testing infrastructure can be successfully leveraged to support HCV testing, but differentiated preventive care delivery is needed for some vulnerable populations.

Moral distress, organizational climate, and the risk of burnout among oncology physician assistants.

11018 Background: Moral Distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care and has been associated with burnout. Advances have been made in our understanding of burnout in the oncology (Onc) workforce but our understanding of MD remains limited. This study was initiated to explore associations between moral distress, burnout, and the organizational climate (OC) for Onc Physician Assistants (PAs). Methods: A national survey of onc PAs was conducted in 2020. MD and Burnout were assessed with the Maslach Burnout Inventory and the Measure of MD – Healthcare Professionals (MMD-HP). To assess OC, the Nurse Practitioner Primary Care OC Questionnaire (NP-PCOCQ) was revised for Onc PAs and assessed professional visibility (PV), administrative relations (AR), physician relations (PR), and professional autonomy and support (PAS). A robust Poisson regression model was used to estimate risk ratios (RR) for burnout associated with MD and OC variables. Results: Respondents who completed the survey included 146 Onc PAs that were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical Onc (73%). Mean MMD-HP score was 71.5 and burnout was reported by 39.7% of PAs. MMD-HP scores did not differ based on specialty, practice setting or practice type. PCOCQ subscale scores were lower for PAs with burnout vs. without burnout (p=0.003 to p < 0.001). Increasing levels of MD were associated with increased levels of emotional exhaustion (p<0.001), depersonalization (p<0.001) and a higher overall rate of burnout. For Low, Medium and High MMD, burnout rates were 10%, 44% and 66% respectively (p<0.001). Risk of burnout was associated with increasing levels of MD, which remained when adjusted for the PCOCQ subscales. An interaction model with the PCOCQ subscales and the association between burnout and MD was not significant. Conclusions: Higher levels of MD and unfavorable organizational climate are associated with Onc PA burnout. The relationship between MD and burnout does not appear to be moderated by organizational climate. Additional research is needed to identify potential moderators of the MD/Burnout relationship. Risk Ratio estimate for Burnout.[Table: see text]

Modelling Determinants of Deaths Attributable to External Causes Among Adults in India

The study aimed at finding the risk factors associated with adult mortality (15–59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20–24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.

Lipophilic vs. hydrophilic statins and psychiatric hospitalizations and emergency room visits in US Veterans with schizophrenia and bipolar disorder

Objective Psychiatric hospitalizations and emergency department (ED) visits are costly, stigmatizing, and often ineffective. Given the immune and kynurenine activation in bipolar disorder (BD) and schizophrenia, as well as the immune-modulatory effects of statins, we aimed to compare the relative risk (RRs) of psychiatric hospitalizations and ED visits between individuals prescribed lipophilic vs. hydrophilic statins vs. no statins. We hypothesized (a) reduced rates of hospitalization and ER utilization with statins versus no statins and (b) differences in outcomes between statins, as lipophilia increases the capability to penetrate the blood–brain barrier with potentially beneficial neuroimmune, antioxidant, neuroprotective, neurotrophic, and endothelial stabilizing effects, and, in contrast, potentially detrimental decreases in brain cholesterol concentrations leading to serotoninergic dysfunction, changes in membrane lipid composition, thus affecting ion channels and receptors. Methods We used VA service utilization data from October 1, 2010 to September 30, 2015. The RRs for psychiatric hospitalization and ED visits, were estimated using robust Poisson regression analyses. The number of individuals analyzed was 683,129. Results Individuals with schizophrenia and BD who received prescriptions for either lipophilic or hydrophilic statins had a lower RR of psychiatric hospitalization or ED visits relative to nonstatin controls. Hydrophilic statins were significantly associated with lower RRs of psychiatric hospitalization but not of ED visits, compared to lipophilic statins. Conclusion The reduction in psychiatric hospitalizations in statin users (vs. nonusers) should be interpreted cautiously, as it carries a high risk of confounding by indication. While the lower RR of psychiatric hospitalizations in hydrophilic statins relative to the lipophilic statins is relatively bias free, the finding bears replication in a specifically designed study. If replicated, important clinical implications for personalizing statin treatment in patients with mental illness, investigating add-on statins for improved therapeutic control, and mechanistic exploration for identifying new treatment targets are natural next steps.

Zoonotic smooth and rough Brucella in dogs: seroprevalence and associated factors in an Atlantic Rainforest area of the state of Paraíba, Northeastern Brazil

ABSTRACT: Canine brucellosisis an infectious disease caused by bacteria of the genus Brucella, with world wide distribution and zoonotic impact, and in humans and animals is a neglected disease. In the present study, the sero prevalence of B. canis and B. abortus were determined in a probabilistic sample of housed dogs from the Atlantic Rainforest area of the state of Paraíba, Brazil, and the factors associated with sero positivity. A total of 386 dogs over three months of age were used. For the search for anti-B.canis antibodies the agar gel immune diffusion test (IDGA) was used as a screening and IDGA+2ME as confirmatory test, and to search for anti-B. abortus antibodies the Rose Bengal test (RBT) test was used. Apparent and real prevalences were calculated, and robust Poisson regression was used to identify factors associated with prevalence. The real prevalence fB. Canis was 12.6% and of B. abortus was 22.8%. The factors associated with sero positivity for B. canis were age greater than 10 years (prevalence ratio; PR = 6.38; P = 0.024) and dogs reared in they ard (PR = 5.20; P = 0.035) and for B. abortus was no treplacement of water of animals everyday (PR = 1.48; P = 0.033). It can be concluded that the prevalence of B. canis and B. Abortus in the region is high, which warns to the adopting of control and prevention measures, as well as greater care in the management of animals, especially for elderly dogs.