Search

Supplemental Digital Content is available in the text, Objective: To estimate the association between weather and COVID-19 fatality rates during US stay-at-home orders. Methods: With a county-level longitudinal design, this study analyzed COVID-19 deaths from public health departments’ daily reports and considered exposure as the 18 to 22 day-period before death. Models included state-level social distancing measures, Census Bureau demographics, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2.5 concentrations, and U.V. light index. Results: A 1 °F increase in the minimum temperature was associated with 1.9% (95% CI, 0.2% to 3.6%) increase in deaths 20 days later. An ozone concentration increase of 1 ppb (part per billion) decreased daily deaths by 2.0% (95% CI, 0.1% to 3.6%); ozone levels below 38 ppb negatively correlated with deaths. Conclusions: Increased mobility may drive the observed association of minimum daily temperature on COVID-19 deaths.

Introduction: The transmission of respiratory infectious diseases such as COVID-19 can significantly decrease by mask-wearing. However, accurate information about the extent and proper use of the facial mask is scarce. This study’s main objective was to observe and analyze mask-wearing behavior and the level of COVID-19 protection measures in indoor public areas (PAs) of Jefferson County, Kentucky. Methods: For conducting the observational survey study, targets were indoor PAs, and zip codes were defined as surveying clusters. The number of selected PAs in each zip code was proportional to the population and the total number of PAs in that zip code. The PA pool in a zip code was divided into four groups, followed by random selection without replacement from each group. Results: A total of 191 PAs were surveyed: 50 of them were grocery stores, 56 were convenience stores or pharmacies, 39 were wine and liquor stores, and 46 were other stores. At least one unmasked and one incorrectly masked staff were observed in 26% and 40% of the sampled PAs, respectively. Also, in 29% and 35% of the PAs, at least one unmasked and one incorrectly masked visitor were observed, respectively. The rates varied by PA size and county district. Eighty percent of unmasked staff and 75% of the unmasked visitors were male. The rate of unmasked males varied from 50% to 100% across districts. About 66% of unmasked staff among all Jefferson County districts were young adults. More than one-fourth of all the PAs provided hand sanitizer for visitors’ use, and only 2% of the PAs provided masks to their visitors. Conclusion: Messaging about mask use and correct usage may need to particularly target the 19-44-year-old male population, as these individuals were the most prevalent among those unmasked and masked incorrectly. Additionally, businesses’ protective measures may depend on their resources to operate in such a manner. Hand sanitizer is easier to offer visitors, while staffing to regularly sanitize carts or funds to provide a sufficient number of wipes, gloves, or masks may present further opportunities for government assistance.

OBJECTIVES The objective of this study was to analyze factors associated with oral health-related quality of life (OHRQoL) between type 2 diabetes mellitus (T2DM) and nondiabetic US adults. METHODS The study sample included 2945 participants (aged ≥20) selected from National Health and Nutrition Examination Survey (NHANES) 2003-2004 that represented 130,689,262 million persons in a probability weighted sample. Oral health outcomes were measured by the NHANES version of Oral Health Impact Profile (OHIP) for OHRQoL and summarized as additive scores (OHIP-ADD) and as prevalence of negative impacts (OHIP-SC). Multiple logistic regression models used dichotomous outcome variables OHIP-ADD and OHIP-SC. The cut-off values for poor OHRQoL were heuristically defined as OHIP-ADD ≥6 and as OHIP-SC > 0. RESULTS Poor OHRQoL was significantly (p

The objective of this study was to analyze the association between tooth loss and uncontrolled diabetes among US adults.The authors used National Health and Nutrition Examination Survey data from 2011 through 2018. The sample included 16,635 participants 20 years and older who represent 187,596,215 people in the United States in a probability weighted sample. The authors used bivariate analysis and multiple regressions to analyze factors associated with edentulism and number of missing teeth.The multiple logistic regression model significantly predicted edentulism using diabetes status (adjusted odds ratio controlled diabetes, 1.44 [95% CI, 1.12 to 1.86]; adjusted odds ratio uncontrolled diabetes, 2.26 [95% CI, 1.33 to 3.85]), missing annual dental visits, seeing a dentist only for treatment, family income below 200% of the federal poverty guideline, being female, being 65 years or older, tobacco smoking, and no college education. After controlling for the same covariates, multiple Poisson regression analysis showed that dentate adults with controlled and uncontrolled diabetes had higher relative risk of tooth loss than those without diabetes (adjusted risk ratio controlled diabetes, 1.52 [95% CI, 1.35 to 1.71]; adjusted risk ratio uncontrolled diabetes, 1.57 [95% CI, 1.35 to 1.83]).US adults with uncontrolled (glycated hemoglobin ≥ 9%) and controlled diabetes (glycated hemoglobin9%) were more likely to be edentulous and experience tooth loss than adults without diabetes.US health policy officials should adopt benefits policies to provide regular dental examinations to people who have diabetes, have low income (200% of the federal poverty guideline), or are 65 years or older to reduce tooth loss and improve their quality of life. Dentists should work with physicians to help patients control glycemic levels.

Background: The prevalence of overweight (OWT) and obesity (OB), defined by the body mass index (BMI, kg/m2) among children and youth has increased worldwide in the last 30–40 years.Aim: To evaluat...

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities’ mask use behavior have mostly relied on self-report. This study’s objective was to devise a method for measuring the prevalence of mask-wearing and proper mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14−20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The average mask use prevalence among observed visitors of the 382 visited public areas was 96%, while the average prevalence of proper use was 86%. In 17% of the public areas, at least one unmasked visitor was among the observed visitors; in 48%, at least one improperly masked visitor was observed. The average mask use among staff was 92%, but unmasked staff were observed in fewer public areas, as an unmasked staff member was observed in 11% of the visited public areas. The average prevalence of proper make use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and incorrectly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, also in food and grocery stores than other retail stores. Also, the majority of the observed unmasked persons were male and middle age adults.

Background The US COVID-19 epidemic impacted counties differently across space and time, though large-scale transmission dynamics are unclear. The study's objective was to group counties with similar trajectories of COVID-19 cases and deaths and identify county-level correlates of the distinct trajectory groups. Methods Daily COVID-19 cases and deaths were obtained from 3141 US counties from January through June 2020. Clusters of epidemic curve trajectories of COVID-19 cases and deaths per 100,000 people were identified with Proc Traj. We utilized polytomous logistic regression to estimate Odds Ratios for trajectory group membership in relation to county-level demographics, socioeconomic factors, school enrollment, employment and lifestyle data. Results Six COVID-19 case trajectory groups and five death trajectory groups were identified. Younger counties, counties with a greater proportion of females, Black and Hispanic populations, and greater employment in private sectors had higher odds of being in worse case and death trajectories. Percentage of counties enrolled in grades 1–8 was associated with earlier-start case trajectories. Counties with more educated adult populations had lower odds of being in worse case trajectories but were generally not associated with worse death trajectories. Counties with higher poverty rates, higher uninsured, and more living in non-family households had lower odds of being in worse case and death trajectories. Counties with higher smoking rates had higher odds of being in worse death trajectory counties. Discussion In the absence of clear guidelines and personal protection, smoking, racial and ethnic groups, younger populations, social, and economic factors were correlated with worse COVID-19 epidemics that may reflect population transmission dynamics during January–June 2020. After vaccination of high-risk individuals, communities with higher proportions of youth, communities of color, smokers, and workers in healthcare, service and goods industries can reduce viral spread by targeting vaccination programs to these populations and increasing access and education on non-pharmaceutical interventions., Graphical abstract Unlabelled Image

Wearing a facial mask can limit COVID-19 transmission. Measurements of communities’ mask use behavior have mostly relied on self-report. This study’s objective was to devise a method to measure the prevalence of improper mask use and no mask use in indoor public areas without relying on self-report. A stratified random sample of retail trade stores (public areas) in Louisville, Kentucky, USA, was selected and targeted for observation by trained surveyors during December 14–20, 2020. The stratification allowed for investigating mask use behavior by city district, retail trade group, and public area size. The total number of visited public areas was 382 where mask use behavior of 2,080 visitors and 1,510 staff were observed. The average prevalence of mask use among observed visitors was 96%, while the average prevalence of proper use was 86%. In 48% of the public areas, at least one improperly masked visitor was observed and in 17% at least one unmasked visitor was observed. The average prevalence of proper mask use among staff was 87%, similar to the average among visitors. However, the percentage of public areas where at least one improperly masked staff was observed was 33. Significant disparities in mask use and its proper use were observed among both visitors and staff by public area size, retail trade type, and geographical area. Observing unmasked and improperly masked visitors was more common in small (less than 1500 square feet) public areas than larger ones, specifically in food and grocery stores as compared to other retail stores. Also, the majority of the observed unmasked persons were male and middle-aged.

Aims To analyse the causal relationships of nutrition intake and physical activity on haemoglobin A1c (HbA1C) in patients diagnosed with type 2 diabetes mellitus (T2DM) stratified by gender and ethnicity. Materials and Methods An historical cohort of patients with diagnosed T2DM (n = 2831) was extracted from the National Health and Nutrition Examination Survey (NHANES) 2011‐2014 public database, including but not limited to, measurements of physical activity, nutrition, body mass index (BMI) and HbA1c. Multivariate analyses and path analyses were employed to estimate the regression coefficients and path coefficients (ρ) of causal path models of physical activity and nutrition intake on HbA1c stratified by gender and three ethnicity groups (ie non‐Hispanic white, non‐Hispanic black and Mexican American). Results A significant causal path from increased physical activity to increased magnesium (Mg) intake to decreased HbA1c was found. In addition, increased physical activity significantly decreased BMI, which further decreased HbA1c. These results varied by gender and ethnicity but were directionally consistent. Physical activity decreased HbA1c through BMI for males and through Mg intake for females. Mexican American decreased HbA1c through Mg intake, while non‐Hispanic black had an increased HbA1c due to its ethnicity and through increased BMI. Conclusions The beneficial effects of physical activity on decreased HbA1c were mediated through the increased Mg intake and decreased BMI. This aligned with recent investigations of the inverse causal association of Mg intake with insulin resistance and with decreased inflammation., We applied causal path analyses to NHANES 2011‐2014 dataset to analyse the causal relationships of nutrition intake and physical activity on HbA1C in patients diagnosed with type 2 diabetes mellitus stratified by gender and ethnicity. We found that the beneficial effects of physical activity on decreased HbA1c were mediated through the increased Mg intake and decreased BMI across different gender and ethnicities.

This study used statistically robust regression models to control for a large set of confounders (including county-level time-invariant factors and time trends, regional-level daily variation, state-level social distancing measures, ultraviolet light, and levels of ozone and fine particulate matter, PM2.5) to estimate a reliable rather than simple regression for the impact of weather on the most accurately measured outcome of COVID-19, death. When the average minimum temperature within a five-day window increased by one degree Fahrenheit in spring 2020, daily death rates in northern U.S. counties increased by an estimated 5.1%. When ozone concentration over a five-day window rose by one part per billion, daily death rates in southern U.S. counties declined by approximately 2.0%. Maximum temperature, precipitation, PM2.5, and ultraviolet light did not significantly associate with COVID-19 mortality. The mechanism that may drive the observed association of minimum temperature on COVID-19 deaths in spring months may be increased mobility and contacts. The effect of ozone may be related to its disinfectant properties, but this requires further confirmation.

Objective: To test the hypothesis that cadmium (Cd) exposure is associated with type 2 diabetes mellitus (T2DM). Materials and Methods: A two-phase health screening (physical examination and laboratory tests) was conducted in a lead smelter community following a Superfund Cleanup. Participants were African Americans aged &gt, 19 years to &lt, 89 years. Multiple logistic regression was used to analyze T2DM regressed on blood Cd level and covariates: body mass index (BMI), heavy metals (Ar, Cd, Hg, Pb), duration of residence, age, smoking status, and sex. Results: Of 875 subjects environmentally exposed to Cd, 55 were occupationally exposed to by-products of lead smelting and 820 were community residents. In addition, 109 T2DM individuals lived in the community for an average of 21.0 years, and 766 non-T2DM individuals for 19.0 years. T2DM individuals (70.3%) were &gt, 50 years old. Blood Cd levels were higher among T2DM subjects (p &lt, 0.006) compared to non-T2DM individuals. Logistic regression of T2DM status identified significant predictors: Cd level (OR = 1.85, 95% CI: 1.14&ndash, 2.99, p &lt, 0.01), age &gt, 50 years (OR = 3.10, 95% CI: 1.91&ndash, 5.02, p &lt, 0.0001), and BMI (OR = 1.07, CI: 1.04&ndash, 1.09, 0.0001). In meta-analysis of 12 prior studies and this one, T2DM risk was OR = 1.09 (95% CI: 1.03&ndash, 1.15, p &lt, 0.004) fixed effects and 1.22 (95% CI: 1.04&ndash, 1.44, p &lt, 0.02) random effects. Discussion: Chronic environmental Cd exposure was associated with T2DM in a smelter community, controlling for covariates. T2DM onset &lt, 50 years was significantly associated with Cd exposure, but &gt, 50 years was not. Meta-analysis suggests that Cd exposure is associated with a small, but significant increased risk for T2DM. Available data suggest Cd exposure is associated with an increased propensity to increased insulin resistance.

Introduction: Six of 14 prior studies reported significant associations between cadmium (Cd) and type 2 diabetes mellitus (T2DM). Materials and Methods: In a Superfund Cleanup community, Phase II screening included physical examination and laboratory tests. Participants were African Americans aged ≥19 years to ≦89 years. Multiple logistic regression was used. Results: Of 873 subjects environmentally exposed, 109 T2DM individuals who lived in the community for an average of 21.0 years, and 766 non-T2DM individuals resident in the study community for 19.0 years. Most T2DM individuals (70.3%) were ≥50 years old (p Discussion: Cd exposure is associated with T2DM in an EPA Superfund community, controlling for covariate effects. Comparing our findings with 14 prior Cd and T2DM studies shows that T2DM rates less than 10% were not sufficiently powered, unless OR ≥ 3.0 (See Figure). Findings suggest that Cd is associated with T2DM, and studies failing to show a significant effect may have a Type II error, and not an indication of no association. Disclosure B.B. Little: None. R.F. Reilly: None. B. Walsh: None.

BACKGROUND: To evaluate the association of statins and co-morbidities with new onset type 2 diabetes mellitus (T2DM) in patients 65 years and older. METHODS: This retrospective study used de-identified administrative healthcare claims and enrolment data from a Medicare Advantage Prescription Drug (MAPD) health plan offered by a large multistate healthcare company. The plan covered >2.4 million individuals, of whom >1.7 million individuals were ≥65 years. Of these, 265 554 individuals had continuous MAPD enrolment January 2008 to December 2015. The unadjusted model assessed demographic, pharmacy and T2DM comorbidities as covariates. Significant variables (P < .05) in the unadjusted model were then included in the adjusted model. The adjusted model used Cox proportional hazards to evaluate covariate effects. Matched propensity score analysis was used to analyse the association of statins and T2DM onset. RESULTS: The cumulative rate of diagnosed T2DM onset in the study cohort was 4.82% (4314/89 390). Annualised incidence of T2DM diagnosis was 0.82%, 0.88%, 1.04% and 2.09% in 2012, 2013, 2014 and 2015, respectively. T2DM onset was associated with male sex, non-white (African American or Hispanic ethnicity), statin use, hypertension, hyperlipidaemia, heart failure, lower limb ulceration, atherosclerosis, other retinopathy, angina pectoris, poor vision and blindness and absence ischaemic heart disease (IHD). Matched propensity score analysis showed that statin use was significantly associated with T2DM onset (Odds Ratio = 1.26, 95% Confidence Interval: 1.12–1.41, P < .0001) in the adjusted model. CONCLUSIONS: Analyses indicated that statin usage was associated with new onset T2DM after adjusting for covariates.

Background: Understanding if and how weather patterns influence the transmission of SARS-CoV-2 will impact public health preparedness, as the second year of the COVID-19 pandemic draws near. However, the research on weather and SARS-CoV-2 transmission has yielded mixed results. This study aimed to estimate the association of weather and COVID-19 fatality rates during the period of stay-at-home orders in U.S. counties. Methods: This study utilized a county-level longitudinal design to examine COVID-19 adult deaths from the stay-at-home orders to reopening. COVID-19 deaths came from public health departments’ daily reports and considered exposure as the 18 to 22 day-period before death. Further, models included information on state-level social distancing measures, Census Bureau demographic information, daily weather information, and daily air pollution. The primary measures included minimum and maximum daily temperature, precipitation, ozone concentration, PM2·5 concentrations, and U.V. light index. Findings: The average minimum daily temperature threshold of 53 to 63 degrees Fahrenheit (°F was positively associated with COVID-19 deaths. A 1°F increase in the average minimum temperature was associated with 1·9% (95% CI, 0·2%−3·6%) increase in deaths about 20 days later. An ozone concentration increase of one ppb (part per billion) decreased daily deaths by 2·0% (95% CI, 0·1%−3·6%). Ozone levels below 38 ppb appeared negatively correlated with deaths. Interpretation: Increased mobility and contacts may drive the observed association of minimum daily temperature on COVID-19 deaths. The effect of ozone may be related to its disinfectant properties, but this requires further confirmation. Funding Statement: No Funding Received. Declaration of Interests: None to declare.

Reduced vital capacity (VC) and forced vital capacity (FVC) are associated with lead (Pb) exposure.The objective of this study is to analyse the effects of Pb on FVC and the shuttle run performance.Data were available for 184 male and 189 female Polish schoolchildren aged 10-15 years. Regression analysis was performed of shuttle run performance (dependent) on Pb and FVC.Shuttle run time increased by 1.75 (± 0.77) and 1.97 (± 0.77) seconds for each 10 µg/dL increase in Pb blood among males and females, respectively. Higher shuttle run times indicate poorer performance. Average unadjusted blood Pb level in the sample was 5.27 μg/dL (± 0.19 SE) and 3.82 μg/dL (± 0.10 SE), respectively. Path analysis was used to assess the association of Pb level with shuttle run time. Blood Pb had a significant negative effect on VC (B= -13.60 ± 3.28 [SE], p 0.0001) and FVC (B = -13.08 ± 3.27, p 0.0001). FVC had a small but significant effect on shuttle run time (B = -0.04 ± 0.007, p 0.0001). Pb had a significant effect on the residual of shuttle run time among males (B = 1.59 ± 0.75, p 0.03) and females after the effect of FVC was removed (B = 1.49 ± 0.73, p 0.04).Thus, Pb had direct and indirect effects that increased shuttle run time, i.e. negatively affected performance.

Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) "remission" in non-bariatric Medicare patients 65 years and older. Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in "remission" if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as "remission"). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM "remission." Results: 4.97% of patients studied met the definition of T2DM "remission" in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM "remission" that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05). Conclusion: T2DM "remission" in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.

Objective. To test the hypothesis that assortative mating for physical characteristics differs before and after major secular increases in height in an indigenous community in the Valley of Oaxaca, Mexico. Methods. Spouse pairs were identified in household and anthropometric surveys of a Zapotec-speaking community in 1978 (n = 68-70 pairs) and 2000 (n = 99-100 pairs). Height, weight, arm circumference, triceps skinfold and grip strength were measured. Assortative mating was calculated as Pearson correlations. Results. Husband-wife correlations for age were high in both years (r = 0.96, 0.95). Assortative mating for height was significant in 1978 (r = 0.35, p 0.05) when ages of spouses were controlled (r = -0.02 to 0.16). Conclusion. Assortative mating for physical characteristics did not differ between surveys conducted before (1978) and after (2000) major secular increases in height in the community, and any possible genetic effect of the secular trend on assortative was likely negligible.

Objective: To analyze the characteristics of individuals who went into remission for type 2 diabetes mellitus (T2DM) in the absence of bariatric surgery in three large population level datasets. Methods: Data from three large T2DM cohorts were used in this analysis: a) 10,059 subjects from a longitudinal Medicare cohort (n=2.4 Million); b) 4,997 subjects, Continuous NHANES (n=82,091); and c) 562 subjects, NHANES III (n=33,994). A Medicare T2DM individual with no T2DM related claims continuously for more than 12 months was considered to be in remission. In the NHANES data T2DM remission was defined as an HbA1c ≤ 5.7 without T2DM related medications. Cox proportional hazards was used to identify significant variables associated with T2DM “remission” in the Medicare data. NHANES data were analyzed with multiple logistic regression with T2DM remission as the dependent variable. Results: In the Medicare dataset 4.97% met the criteria for T2DM remission in a five-year longitudinal study, while 2.76% and 1.97% of the continuous NHANES and the NHANES III subjects, respectively, achieved remission in the cross-sectional cohorts. The factors associated with T2DM remission were no statin use; no insulin use; no hypertension; no hyperlipidemia; no neuropathy; no retinopathy; female gender; non-African American ethnicity; decreased waist circumference and lower systolic blood pressure (Bonferroni adjusted p≤0.05). The rate of T2DM remission appears to be approximately 1.97 to 4.97%. Conclusions: T2DM remission triggers exist (Lancet, Dec 2017). Of the factors associated with T2DM remission, only ethnicity and gender are non-modifiable risk factors. Therefore, diabetes prevention and management programs should concentrate on lowering body weight, lipids, and blood pressure. Management of these factors is associated with T2DM remission. Identification of other factors associated with T2DM may lead to more efficacious programmatic management of the disease and attenuation of serious co-morbidities. Disclosure S. Tangelloju: Employee; Self; Humana Inc.. G. Vu: None. H. Chavis-Blakely: None. B.B. Little: None.

Studies have shown a reduction in major bleeding with trans-radial intervention (TRI) compared with trans-femoral intervention (TFI), and with use of bivalirudin compared with heparin + glycoprotein IIb/IIIa inhibitors (GPI). We compared major bleeding and mortality in Veterans stratified by