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Background: Recent data in nonpregnant individuals suggest a protective effect of influenza vaccination against SARS‐CoV‐2 infection and its severity. Objectives: Our primary objective was to evaluate whether influenza vaccination was associated with COVID‐19 severity and pregnancy and neonatal outcomes among those infected with SARS‐CoV‐2. The secondary objective was to examine the association between influenza vaccination and SARS‐CoV‐2 infection. Study Design: Secondary analysis of a multicenter retrospective cohort of pregnant people who tested positive for SARS‐CoV‐2 between March and August 2020, and a cohort of random deliveries during the same time period. The associations between 2019 influenza vaccination and the primary outcome of moderate‐to‐critical COVID‐19 as well as maternal and perinatal outcomes were examined among all people who tested positive for SARS‐CoV‐2 between March and August 2020. The association between 2019 influenza vaccination and having a positive SARS‐CoV‐2 test was examined among a cohort of individuals who delivered on randomly selected dates between March and August 2020. Univariable and multivariable analyses were performed. Results: Of 2325 people who tested positive for SARS‐CoV‐2, 1068 (45.9%) were vaccinated against influenza in 2019. Those who received the influenza vaccine were older, leaner, more likely to have private insurance, and identify as White or Hispanic. They were less likely to smoke tobacco and identify as Black. Overall, 419 (18.0%) had moderate, 193 (8.3%) severe, and 52 (2.2%) critical COVID‐19. There was no association between influenza vaccination and moderate‐to‐critical COVID‐19 (29.2% vs. 28.0%, adjusted OR 1.10, 95% CI 0.90–1.34) or adverse maternal and perinatal outcomes among those who tested positive. Of 8152 people who delivered in 2020, 4658 (57.1%) received the influenza vaccine. Prior vaccination was not associated with a difference in the odds of SARS‐CoV‐2 infection (3.8% vs. 4.2%, adjusted OR 0.94, 95% CI 0.74–1.19). Conclusion: Prior influenza vaccination was not associated with decreased severity of COVID‐19 or lower odds of SARS‐CoV‐2 infection in pregnancy. [ABSTRACT FROM AUTHOR]

Introduction: Heavy metals such as Lead (Pb) and Mercury (Hg) can affect adipose tissue mass and function. Considering the high prevalence of exposure to heavy metals and obesity in Mexico, we aim to examine if exposure to Pb and Hg in adolescence can modify how fat is accumulated in early adulthood. Methods: This study included 100 participants from the ELEMENT cohort in Mexico. Adolescent Pb and Hg blood levels were determined at 14–16 years. Age‐ and sex‐specific adolescent BMI Z‐scores were calculated. At early adulthood (21–22 years), fat accumulation measurements were performed (abdominal, subcutaneous, visceral, hepatic, and pancreatic fat). Linear regression models with an interaction between adolescent BMI Z‐score and Pb or Hg levels were run for each adulthood fat accumulation outcome with normal BMI as reference. Results: In adolescents with obesity compared to normal BMI, as Pb exposure increased, subcutaneous (p‐interaction = 0.088) and visceral (p‐interaction < 0.0001) fat accumulation increases. Meanwhile, Hg was associated with subcutaneous (p‐interaction = 0.027) and abdominal (p‐interaction = 0.022) fat deposition among adolescents with obesity. Conclusions: Heavy metal exposure in adolescence may alter how fat is accumulated in later periods of life. [ABSTRACT FROM AUTHOR]

Aim: Large‐scale functional diversity studies typically examine isolated traits, often without phylogenetic context. Here, we integrate data from five life‐history traits with phylogeny and occurrence records to assess: (a) correlated latitudinal gradients of trait combinations; (b) which traits show phylogenetic conservatism and (c) quantitative, clade‐specific differences in trait syndromes, illustrating the phylogenetic scale of observable variation in ecological strategies. Location: The Americas. Taxon: Ericales (Asterids) and Fabales (Rosids). Methods: We used publicly available trait data sets on height, seed mass, wood density, leaf mass per area (LMA) and growth form, an open‐source phylogeny, and georeferenced occurrence records to investigate functional diversity patterns. We employed phylogenetic generalized least squares and phylogenetic principal components analyses (pPCA) to assess correlated trait evolution and quantify the trait syndrome, respectively. We employed the InfoMap Ecoregions web app to cluster species by bioregions. We used standard statistical tests and randomization simulations to assess statistical significance of results. Results: Ericales and Fabales exhibited a biogeographically consistent, phylogenetically conserved trait syndrome. Moving poleward, species exhibited progressively smaller trait values and more herbaceous and shrubby growth forms (except for LMA, which showed no consistent pattern). We quantified latitudinal variation in this trait syndrome using pPCA, and provide evidence for correlated trait evolution. Main conclusions: We demonstrate a functional trait syndrome involving height, seed mass, wood density and growth form, but not LMA. Functional trait values showed consistent latitudinal patterns and evidence of correlated evolution, suggesting an underlying ecological strategy. Furthermore, the two clades showed quantitative differences in the manifestation of this trait syndrome. Variation in the syndrome was best observed among species from con‐ordinal families. We interpret this trait syndrome as a strategy of resource acquisition in which habitats with relatively greater soil nutrient content and a shorter growing season favour shorter stature, lower seed mass and wood density, and shrubby or herbaceous growth form. [ABSTRACT FROM AUTHOR]

Objective: Hispanic populations typically show a high prevalence of dyslipidemias, especially of low high‐density lipoproteins (HDLs) or HDL cholesterol. Highly admixed populations are ideal groups to clarify the role of genetic ancestry on HDL concentrations, isolating it from that of other factors. The objective of this study was to estimate the association between Native American genetic ancestry and HDL‐cholesterol levels independent of socioeconomic factors in a representative sample of the Mexican population. Methods: We used data from the Mexican National Health Survey 2000, analyzing 1647 subjects from whom stored DNA samples and HDL measurements were available. To estimate proportional genetic ancestry (Native American, African, and European), we used a 107 genetic ancestry informative marker panel with the software STRUCTURE. To estimate the association between genetic ancestry and low HDL levels, we fitted logistic regression models with the percentage of Native American genetic ancestry, in quartiles, as the main predictor. Results: Mean HDL levels were 38.9 mg/dL, with 62% of subjects having levels below 40 mg/dL. Participants had on average 53.6% Native American, 39% European, and 7.3% African genetic ancestry. Those in the fourth quartile of Native American genetic ancestry had 35% higher odds of having low HDL‐cholesterol relative to those in the first quartile (odds ratio, 1.35; 95% confidence interval, 0.99‐1.81) after adjustment for socioeconomic level and other covariates, although the association is clearly nonlinear. Conclusion: Native American genetic ancestry seems to play a small but distinct role in the development of low HDL cholesterol levels. [ABSTRACT FROM AUTHOR]

Tropical forests challenge us to understand biodiversity, as numerous seemingly similar species persist on only a handful of shared resources. Recent ecological theory posits that biodiversity is sustained by a combination of species differences reducing interspecific competition and species similarities increasing time to competitive exclusion. Together, these mechanisms counterintuitively predict that competing species should cluster by traits, in contrast with traditional expectations of trait overdispersion. Here, we show for the first time that trees in a tropical forest exhibit a clustering pattern. In a 50‐ha plot on Barro Colorado Island in Panama, species abundances exhibit clusters in two traits connected to light capture strategy, suggesting that competition for light structures community composition. Notably, we find four clusters by maximum height, quantitatively supporting the classical grouping of Neotropical woody plants into shrubs, understory, midstory, and canopy layers. [ABSTRACT FROM AUTHOR]

Trisomy 18 is an autosomal trisomy condition characterized by minor to major birth defects, severe disabilities, and high rates of pre‐ and postnatal mortality. Interventions for these infants have traditionally been withheld with focus instead on palliative support. The issues and attitudes surrounding corrective surgery of congenital heart defects, which is a birth defect that occurs in approximately 90% of infants with trisomy 18, is of our study's interest as recent literature has indicated that cardiac surgery is being performed and may lead to improved survival compared to palliative care. Thus, our study aimed to describe clinician attitudes toward cardiac surgery and trisomy 18. We surveyed 378 clinicians from multiple specialties, including genetic counselors, involved in the pre‐ and postnatal care of infants with trisomy 18. Descriptive statistics were performed to describe all clinicians' responses, and a secondary analysis with stratifications by clinician type was also performed. Forty‐eight percent (n = 378) of clinicians felt it was appropriate to discuss the option of cardiac surgery. Ethical concerns and insufficient outcome data were the most agreed upon reasons for not offering cardiac surgery. Trisomy 18 not being uniformly lethal and expressed parental wishes were the most agreed upon justifications for offering surgery. Clinicians felt the discussion of the option of cardiac surgery is appropriate, however are hesitant due to ethical concerns and insufficient outcome data. Results from this study aim to promote discussion and collaboration among clinicians to improve consistency in patient care. [ABSTRACT FROM AUTHOR]

Recognizing the heterogeneity of the Asian population with regards to acculturation, education, health awareness, and cultural values is vital for tailoring culturally sensitive and appropriate care. Prior studies show that cultural values influence perceptions of genetics within Asian populations. The reputation of the family unit factors into decisions such as pregnancy termination and disclosure of family medical history, and the nondirective model of American genetic counseling may conflict with the historical Asian model of paternalistic health care. Previous studies also provide conflicting evidence regarding correlations between education, acculturation, age, and awareness and perceptions of genetic testing. The aims of this study were to describe attitudes towards prenatal genetics among Southeast and East Asian women living in the United States for varying amounts of time and to explore sociocultural factors influencing those attitudes. Twenty-three Asian women who were members of Asian cultural organizations in the United States were interviewed via telephone about their attitudes towards prenatal genetic counseling, prenatal genetic testing, and termination of pregnancy. Responses were transcribed and coded for common themes using a thematic analysis approach. Four major themes emerged. In general, participants: (1) had diverse expectations for genetic counselors; (2) tended to weigh risks and benefits with regards to genetic testing decisions; (3) had mixed views on termination for lethal and non-lethal genetic conditions; and (4) identified cultural factors which influenced testing and termination such as lack of available resources, societal shame and stigma, and family pressure. These findings may allow prenatal genetic counselors to gain a richer, more nuanced understanding of their Asian patients and to offer culturally tailored prenatal genetic counseling. [ABSTRACT FROM AUTHOR]

Religion and spirituality (R/S) are important components of many individuals' lives, and spirituality is often employed by women coping with pregnancy complications. To characterize how prenatal genetic counselors might address spiritual issues with patients, 283 English and Spanish speaking women receiving prenatal genetic counseling in Houston, Texas were surveyed post-counseling using both the Brief RCope and questions regarding interest in spiritual exploration. Genetic counselors were concurrently surveyed to identify religious/spiritual language used within sessions and perceived importance of R/S. Genetic counselors were significantly more likely to identify R/S as important to a patient when patients used religious/spiritual language ( p < 0.001). Conversely, when no religious/spiritual terms were present, the counselor felt uncertain about the importance of R/S 63 % of the time. However, 67 % of patients reported that they felt comfortable sharing their faith as it relates to their pregnancy, and 93 % reported using positive religious coping. Less than 25 % reported a desire for overt religious actions such as prayer or scripture exploration. Therefore, most patients' desires for spiritual exploration center in the decision making and coping processes that are in line with the genetic counseling scope of practice. Thus, counselors should feel empowered to incorporate spiritual exploration into their patient conversations. [ABSTRACT FROM AUTHOR]

Key content In order to provide appropriate counselling about the risk to future pregnancies imposed by caesarean delivery, providers must be knowledgeable about and able to synthesise a multitude of variables such as institutional policies, the clinical implications of each current delivery option for future pregnancies, patient understanding of maternal and neonatal risks and benefits, the woman's reasons for requesting this type of delivery and the woman's desired family size., The rate of successful vaginal birth after caesarean section ranges 50-85%, with lower rates associated with both modifiable factors (gestational age >40 weeks, maternal obesity, short interpregnancy interval and increased birthweight) and non-modifiable factors (maternal age, non-white ethnicity, pre-eclampsia and recurrence of the indication for the initial caesarean delivery)., In future pregnancies, the risk of adverse outcomes such as haemorrhage, endometritis, operative injury, hysterectomy and maternal death goes up with each additional caesarean section., Learning objectives To be knowledgeable about and able to provide accurate counselling for three important clinical situations: caesarean delivery on maternal request; women with a history of one or two caesarean deliveries; and women with a history of three or more caesarean deliveries., Ethical issues When counselling women about the risks of caesarean delivery on future pregnancies, providers should always consider the principles of beneficence and non-maleficence while synthesising a myriad of scenarios and outcomes. If properly counselled on the risks, benefits and alternatives of a delivery decision, her autonomy should be respected. [ABSTRACT FROM AUTHOR]

To determine the factors associated with the dental health services utilization among children ages 6 to 12 in León, Nicaragua. A cross-sectional study was carried out in 1,400 schoolchildren. Using a questionnaire, we determined information related to utilization and independent variables in the previous year. Oral health needs were established by means of a dental examination. To identify the independent variables associated with dental health services utilization, two types of multivariate regression models were used, according to the measurement scale of the outcome variable: a) frequency of utilization as (0) none, (1) one, and (2) two or more, analyzed with the ordered logistic regression and b) the type of service utilized as (0) none, (1) preventive services, (2) curative services, and (3) both services, analyzed with the multinomial logistic regression. The proportion of children who received at least one dental service in the 12 months prior to the study was 27.7 percent. The variables associated with utilization in the two models were older age, female sex, more frequent toothbrushing, positive attitude of the mother toward the child's oral health, higher socioeconomic level, and higher oral health needs. Various predisposing, enabling, and oral health needs variables were associated with higher dental health services utilization. As in prior reports elsewhere, these results from Nicaragua confirmed that utilization inequalities exist between socioeconomic groups. The multinomial logistic regression model evidenced the association of different variables depending on the type of service used. [ABSTRACT FROM AUTHOR]

Numerous studies have established associations between single nucleotide polymorphisms (SNPs) and various behavioral and neurodevelopmental conditions. This study explores the links between SNPs in candidate genes involved in central nervous system (CNS) physiology and their implications for the behavioral and emotional aspects in children and teenagers. A total of 590 participants, aged 7–15 years, from the Early Life Exposures In Mexico To Environmental Toxicants (ELEMENT) cohort study in Mexico City, underwent genotyping for at least one of 15 CNS gene‐related SNPs at different timepoints. We employed multiple linear regression models to assess the potential impact of genetic variations on behavioral and cognitive traits, as measured by the Behavioral Assessment System for Children (BASC) and Conners parent rating scales. Significant associations were observed, including the rs1800497 TC genotype (ANKK1) with the Cognitive Problems/Inattention variable (p value = 0.003), the rs1800955 CT genotype (DDR4) with the Emotional Lability Global index variable (p value = 0.01), and the rs10492138 GA and rs7970177 TC genotypes (GRIN2B) with the Depression variable (p values 0.007 and 0.012, respectively). These finds suggest potential genetic profiles associated with “risk” and “protective” behaviors for these SNPs. Our results provide valuable insights into the role of genetic variations in neurobehavior and highlight the need for further research in the early identification and intervention in individuals at risk for these conditions. [ABSTRACT FROM AUTHOR]