Changes in plasma adipokines in prepubertal children with a history of extrauterine growth restriction

ObjectiveBecause nutritional support in perinatal life has been associated with metabolic programming, children with a history of extrauterine growth restriction (EUGR) might display alterations in the adipocyte and in the secretion of adipokines. The aim of this study was to assess adiponectin, resistin, and leptin concentrations in prepubertal children with a history of EUGR, and to determine the potential correlation between these adipokines and metabolic parameters.MethodsThis case–control study sample included 38 prepubertal children with a history of EUGR and a control group of 123 healthy children of similar age and sex. Anthropometric measures and blood pressure were assessed. Biochemical markers and blood adipokine concentrations (adiponectin, resistin, and leptin) were evaluated.ResultsAdiponectin concentration was significantly lower in the EUGR group compared with controls (EUGR: 11.49 ± 6.07 versus control: 25.72 ± 10.13 μg/mL), and resistin concentration was higher (EUGR: 20332.95 ± 6401.25 versus control: 8056.31 ± 3823.63 pg/mL), even after adjustment for gestational age, weight, and size at birth. Systolic blood pressure was associated with adipokines concentrations in the EUGR group (P < 0.001). In EUGR children adiponectin was associated with high-density lipoprotein cholesterol (P = 0.042), whereas resistin was associated with carbohydrate metabolism parameters (P < 0.001).ConclusionsEarly postnatal malnutrition in EUGR children could program adipose tissue. Plasma adipokines can be measured in childhood to identify precocious changes that may be associated with a higher risk for metabolic syndrome or cardiovascular disease later in life.     

Les taux sériques des lipides,de l’insuline,de la leptine et de la résistine chez des enfants tunisiens obèses et non obèses

BackgroundObesity in children is a public health problem around the world. Its pathogenesis is not yet elucidated. The fatty tissue, a long time considered as a structure of storage, is now recognized as an endocrine structure, secreting adipokines which would participate in the genesis of obesity. The correlation between the leptin and obesity is largely known. On the other hand, the role of the resistin and its implication in the comorbidities of obesity, inter alia the insulinoresistance, remain a controversial subject.ObjectivesThe main objective of our study is to compare the serum concentrations of glucose, lipidic parameters, resistin, leptin and insulin between two samples of obese and non-obese children, and to search correlations between resistin on the one hand and leptin, insulin, BMI, age and sex on the other hand.ResultsWe note that 92 obese children and 72 non-obese children aged between 6 to 10 years old were included in the study. Serum levels of leptin, insulin and resistin were significantly higher in the obese sample. Among obese children, resistin was correlated significantly with BMI (r = 0.798; P < 0.001), leptin (r = 0.635; P < 0.001) and insulin (r = 0.760; P < 0.001). Among non-obese, resistin was significantly correlated with BMI (r = 0.686; P < 0.001), leptin (r = 0.329; P < 0.001) and insulin (r = 0.844; P < 0.01). We did not find any significant correlation between either resistin and age or lipidic parameters neither in the first group nor in the second. In multivariate analysis, resistin did not appear to be related directly with obesity, only leptin was related with this status.ConclusionOur results prove that resistin is correlated with BMI. However, it is not related directly to obesity. Its action seems to be modulated and controlled by leptin.     

Adipokines as uremic toxins

The adipose tissue has pleiotropic functions far beyond the mere storage of energy, and it secretes a number of hormones and cytokines, called adipokines, which have biological effects that impact heath and disease. Adipokines are markedly elevated in the plasma of uremic patients, mainly due to decreased renal excretion. They have pluripotent signaling effects on inflammation/oxidative stress (leptin, adiponectin, resistin), protein-energy wasting (leptin, adiponectin), insulin signaling (adiponectin, leptin, visfatin), endothelial dysfunction (visfatin), and vascular damage (adiponectin, leptin, resistin), which are prevalent in uremic patients. Obesity superimposed to uremia may further aggravate hyperadipokinemia, with the exception of adiponectinemia, which is mitigated by adiposity. Among adipokines and until more data become available, only leptin may be considered as a full uremic toxin owing to adverse effects on protein-energy wasting, cardiovascular damage, inflammation, and the immune system, which have been documented both clinically and experimentally. Resistin and visfatin display some features of uremic toxins, but more data are needed to consider these adipokines as true uremic toxins. In contrast, high levels of adiponectin and chemerin seen in uremia appear to be beneficial. Further research is needed to investigate whether selective removal of leptin, resistin, and visfatin and increments of adiponectin and chemerin levels may have clinical relevance in uremic patients.     

Sexual behaviors and intention for cervical screening among HPV-vaccinated young Chinese females

Background and objectivesHuman papillomavirus (HPV) vaccination and cervical screening prevent cervical cancer effectively. However, there are concerns whether vaccination leads to high-risk sexual behaviors and less intention for cervical screening. We aimed to evaluate the influence of HPV vaccination on high-risk sexual behaviors, and intention for cervical screening among young Chinese females. We also reported the latest HPV vaccination uptake in Hong Kong.MethodsA population-based survey was conducted between September 2016 and January 2017. Subjects were school-age girls from twenty-five secondary schools (in-school) and community females between 18 and 27 years (out-school). Demographics, vaccine-related attitudes, intention for cervical screening and participants’ sexual behaviors were examined.ResultsWe surveyed 2260 females from in-school (n = 1664) and out-school (n = 596) settings. 11.5% in-school and 23.5% out-school participants received at least one dose of HPV vaccine. Vaccination was not associated with age (in-school Odds Ratio [OR] 0.99, p = 0.87; out-school OR 1, p = 0.94), ethnicity (in-school OR 0.82, p = 0.72; out-school OR 0, p = 0.98), maternal education (in-school OR for secondary school 1.19, p = 0.43; for post-secondary school 1.28, p = 0.48), underage sex (in-school OR 1.22, p = 0.80; out-school OR 0.63, p = 0.67), earlier sexual exposure (in-school β 0.01, p = 0.99; out-school β 0.13, p = 0.68), multiple sex partners (in-school OR 3.27, p = 0.22; out-school OR 1.16, p = 0.43), and unprotected sex (in-school OR 1.14, p = 0.78; out-school OR 0.60, p = 0.10). Out-school females with higher personal education level was associated with higher vaccine uptake (post-secondary OR 3.4, p < 0.001; bachelor’s degree or above OR 3.71, p < 0.001). More vaccinated females intended for cervical screening (in-school 23.6% vs. 21.1%; out-school 53.6% vs. 43.6%). Costs and knowledge were important factors for non-vaccination and non-intention for cervical screening.ConclusionsHPV vaccination was not associated with earlier and high risk sexual behavior among Chinese young females. Vaccinated Chinese young females had a higher intention for cervical screening.     

Circulating adipokines and the protective effects of hyperinsulinemia in inflammatory bowel disease

OBJECTIVE: Adipokines are fat-derived hormones and cytokines with immune-modulating and metabolic properties. Most of them are associated with insulin resistance. The aim of the present investigation was to evaluate circulating levels of adipokines and glucose homeostasis in patients with inflammatory bowel disease (IBD) and to evaluate possible associations with the course and characteristics of the disease. METHODS: Serum leptin, resistin, visfatin, retinol-binding protein-4, adiponectin, glucose, insulin, and inflammatory parameters were analyzed in 93 patients with inactive IBD (49 with Crohn's disease [CD], 44 with ulcerative colitis [UC]), 35 patients with active IBD (18 with CD, 17 with UC), and 37 age- and body mass index-matched healthy controls. Ninety-two patients were followed for 6 mo. RESULTS: Leptin was similar in patients with IBD and controls, whereas resistin and visfatin were increased in patients with active disease but not in those in remission. In active and inactive disease, adiponectin was decreased (P < 0.001) and retinol-binding protein-4 was increased (P < 0.001) compared with controls. About 60% of patients with IBD showed increased levels of insulin, whereas serum glucose remained normal, resulting in increased homeostasis model assessment values in most patients. Hyperinsulinemia was associated with the decrease in adiponectin (r = -0.572, P < 0.001) and proved to be an independent protective factor for 6-mo maintenance of remission (P = 0.016). CONCLUSION: IBD led to largely similar alterations in circulating adipokines and hyperinsulinemia in patients with CD and those with UC. The unexpected protective effect of hyperinsulinemia on relapse rate denotes the role of the metabolic-inflammatory response as a modulator in IBD.     

Exercise interventions ameliorate neuropsychiatric symptoms in dementia: A meta-analysis

ObjectivesThis meta-analysis was aimed at systematically synthesizing the effects of exercise interventions on neuropsychiatric symptoms in individuals with dementia. The possible moderators that may influence intervention effects were also examined.MethodsWe searched seven databases (PubMed, Web of Science, SCOPUS, SportDiscus, Ebsco, China National Knowledge Infrastructure, and Wanfang) for randomized clinical trials. The pooled effect sizes were computed by the standardized mean difference (SMD) from post-intervention scores using random-effects models. Potential moderators were also explored by performing subgroup analyses and meta-regression. The risk of bias for included studies was evaluated by the Cochrane Risk of Bias 2.0 Tool.ResultsA total of 22 effect sizes from 17 studies (n = 1344) fulfilled the inclusion criteria. The results indicated that exercise interventions had a small but significant effect on neuropsychiatric symptoms in dementia (SMD = −0.27, 95% CI [−0.40,−0.14], p < 0.001). Subgroup analyses showed that intervention frequency and disease severity moderated the effects. Specifically, interventions with medium-frequency (3 times/week) had a positive effect on neuropsychiatric symptoms (SMD = −0.5, 95% CI [−0.65, −0.34], p < 0.001), but not with low-frequency (1–2 times/week) (SMD = −0.07, 95% CI [−0.22, 0.08], p = 0.38) or high-frequency (4–7 times/week) (SMD = −0.11, 95% CI [−0.36, 0.14], p = 0.38). Interventions had a beneficial effect on neuropsychiatric symptoms in people with mild dementia (SMD = −0.48, 95% CI [−0.71, −0.26], p < 0.001), and moderate dementia (SMD = −0.21, 95%CI [−0.37, 0.05], p < 0.05), but not severe dementia (SMD = −0.01, 95% CI [−0.33, 0.3], p = 0.94).ConclusionsExercise interventions effectively improve neuropsychiatric symptoms in mild and moderate dementia patients. Interventions occurring three times per week were associated with significant effects. Our findings provide evidence that exercise interventions may be an accessible and effective means for improving dementia patients' neuropsychiatric symptoms.     

Anti-obesity effects of aerobic exercise along with Rosa canina seed extract supplementation in rats: The role of irisin and adipolin

Aerobic exercise and some bioactive compounds in medicinal plants have anti-obesity effects and can suppress body weight. The aim of this study was to determine the anti-obesity effects of 6 weeks of aerobic exercise (AE) and supplementation of the hydroalcoholic extract of Rosa canina fruit seed (RC) in obese male rats. In this experimental study, 24 high-fat diet (HFD) obese male Wistar rats were used. The animals were randomly divided into 4 groups (6 rat in group), including 1. HFD (the control group), 2. HFD + AE, 3. HFD + RC and 4. HFD + AE + RC. An obesity protocol was implemented for 12 weeks with the consumption of HFD along with the consumption of water containing 1 % fructose. Afterwards, the animals were given access only to HFD food until the end of the study in all the groups. After the obesity protocol, 6 weeks of exercise (50–70 % VO₂ max) and access to the extract (1 % of the consumed food) were given. Bodyweight, subcutaneous adipose tissue mass, and some serum lipid profiles were measured in the experimental groups. The serum levels of irisin and adipolin were evaluated by the ELISA method. Expression of FNDC5 and CTRP12 in adipose tissue were determined by real-time PCR. The findings of this study showed that body weight (P = 0.001), subcutaneous adipose tissue mass (P = 0.001), and lipid profile were significantly reduced in HFD + AE and HFD + AE + RC groups compared with the HFD group. Irisin was significantly increased in the HFD + AE and HFD + AE + RC groups compared with the HFD group (P = 0.019 and P = 0.001; respectively) and in the HFD + AE + RC group compared with the HFD + RC group (P = 0.004). Moreover, adipolin, expression of FNDC5 and CTRP12 were significantly increased in the HFD + AE + RC group compared with the HFD group (P = 0.004, P = 0.023, and P = 0.001; respectively). Altogether, HFD + AE with HFD + RC diet supplementation could reduce weight and the risks of obesity, at least, through the up-regulation of irisin and adipolin.     

Improved plasmablast response after repeated pneumococcal revaccinations following primary immunization with 13-valent pneumococcal conjugate vaccine or 23-valent pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia

BackgroundPatients with chronic lymphocytic leukemia (CLL) show an immune dysfunction with increased risk of infections and poor response to vaccination. Streptococcus pneumoniae is a common cause of morbidity and mortality in CLL patients. In a previous randomized clinical trial, we found a superior immune response in CLL patients receiving conjugated pneumococcal vaccine compared to non-conjugated vaccine. The response to revaccination in CLL patients is scarcely studied. In this study, early humoral response to repeated revaccinations with pneumococcal vaccines was evaluated, by determination of B cell subsets and plasmablast dynamics in peripheral blood.MethodCLL patients (n = 14) and immunocompetent controls (n = 31) were revaccinated with a 13-valent pneumococcal conjugate vaccine (PCV13) after previous primary immunization (3–6 years ago) with PCV13 or a 23-valent pneumococcal polysaccharide vaccine (PPSV23). Eight weeks after the first revaccination, all CLL patients received a second revaccination with PCV13 or PPSV23. B cell subsets including plasmablasts were analyzed in peripheral blood by flow cytometry, before and after the first and the second revaccination.ResultsNone of the CLL patients, but all controls, had detectable plasmablasts at baseline (p < 0.001). After the first revaccination with PCV13, the plasmablast proportions did not increase in CLL patients (p = 0.13), while increases were seen in controls (p < 0.001). However, after a second revaccination with PCV13 or PPSV23, plasmablasts increased compared to baseline also in CLL patients (p < 0.01). If no response was evident after first revaccination, only a second revaccination with PCV13 increased plasmablasts in contrast to PPSV23 revaccination. Patients with hypogammaglobulinemia and ongoing/previous CLL specific treatment responded poorly, also to a second revaccination.ConclusionIn CLL patients, pneumococcal revaccination induced minor early plasmablast response compared to controls, but the response improved using a strategy of repeated doses with of conjugated T cell dependent pneumococcal vaccine.     

Facilitators and barriers of Hepatitis B screening and vaccination

BackgroundHepatitis B virus (HBV) infection is the most common cause of liver disease and liver cancer in Singapore, being endemic despite availability of an efficacious vaccine.ObjectiveTo assess the factors associated with HBV screening and vaccination.MethodsUsing mixed methods analysis, focus group discussions were conducted alongside a cross-sectional study amongst 784 Singapore Citizens and Permanent Residents aged 25–69 residing in Housing and Development Board (HDB) flats.ResultsAmongst the respondents, 50.6% were screened and 37.8% were vaccinated. The self-reported prevalence of HBV infection was 3.4% and that of HBsAg seropositivity among those screened was 4.3%. Routine health screening was the most common reason cited for screening (32.9%) while doctors’ recommendation was the most common reason for vaccination (42.7%). For both screening and vaccination, knowledge and cost were the top facilitators and barriers respectively. Multivariable regression models revealed the most significant predictors for not undergoing screening to be poor knowledge (p < 0.001), the presence of stigma (p = 0.040) and not being employed in a healthcare sector (p = 0.022), while factors associated with not undergoing vaccination are that of having not undergone screening (p < 0.001) and the lack of importance placed on the knowledge of the possibility of HBV being a silent killer (p = 0.006).ConclusionSeveral facilitators and barriers are seen to regulate health-seeking behaviour towards HBV infection. Public initiatives including education and financial relief targeting specific population groups should be considered to increase the uptake of HBV screening and vaccination.     

Effect of zinc supplementation on blood sugar control in the overweight and obese population: A systematic review and meta-analysis of randomized controlled trials

BackgroundAlthough overweight and obese people have a higher risk of type 2 diabetes incidence than normal-weight individuals, the efficacy of zinc supplementation in blood sugar control in overweight and obese people remained unknown. This meta-analysis attempted to address this issue.MethodsDatabases including PubMed, Embase, and the Cochrane Library were searched from inception until May 2022 to identify randomized controlled trials (RCTs) investigating the effects of zinc supplementation among participants who were overweight or obese without language restriction. It is a random-effect meta-analysis that analyzed the impact of zinc supplementation on fasting glucose (FG) (i.e., primary outcome) and other variables including fasting insulin (FI), homeostasis model assessment-insulin resistance index (HOMA-IR), glycated hemoglobin (HbA1c), high-sensitivity C-reactive protein (hs-CRP), and 2-hour postprandial glucose (2 h- PG).ResultsAnalysis of 12 eligible RCTs involving 651 overweight/obese participants demonstrated that zinc supplementation significantly improves FG (weighted mean difference [WMD]: −8.57 mg/dL; 95% confidence interval [CI]: −14.04 to −3.09 mg/dL, p = 0.002), HOMA-IR (WMD: −0.54; 95% CI: −0.78 to −0.30, p < 0.001), HbA1c (WMD: −0.25%; 95% CI: −0.43% to −0.07%, p = 0.006), and 2 h-PG (WMD: −18.42 mg/dL; 95% CI: −25.04 to −11.79 mg/dL, p < 0.001) compared to those in the control group. After conducting subgroup analyses, we found that the primary outcome, FG, showed more significant results in the subgroups with Asia, Zinc supplementation alone, higher dose (≥30 mg) and patients with diabetes.ConclusionOur meta-analysis indicated that zinc supplementation benefits blood sugar control in overweight and obese populations, with an especially significant reduction in FG.     

Circulating adipokines and risk of obesity related cancers: A systematic review and meta-analysis

BackgroundObesity can influence on carcinogenesis through alterations in adipokines and subsequent inflammatory changes. This meta-analysis was aimed to comprehensively assess the association between circulating adipokines and risk of obesity-related cancers.MethodsPubmed and Embase were searched up to October 2017 for observational studies investigating the relationship between adipokines and cancers. Pooled odds ratio and the corresponding 95% confidence interval was estimated through the meta-analysis using a random-effects model.Findings A total of 93 observational studies (adiponectin = 60, high molecular weight adiponectin = 9, leptin = 39, IL-6 = 16, TNF-α = 10, and resistin = 17) were included. Adiponectin was significantly associated with decreased risk of cancer (pooled OR 0.70, 95% CI 0.60–0.80; I² = 71.9%; P_{heterogeneity} <0.01). Leptin was significantly associated with increased risk of cancer (1.26, 1.05–1.51; I² = 65.7%; P_{heterogeneity} <0.01). For each 5 μg/ml increase in adiponectin and 5 ng/ml increase in leptin, the pooled OR was 0.88 (0.83–0.93; I² = 80.2%; P_{heterogeneity} <0.01) and 1.05 (1.01–1.09; I² = 67.9%; P_{heterogeneity}<0.01)), respectively. There was nonlinear dose-response association (P_nonlinearity for adiponectin = 0.01; P_nonlinearity for leptin = 0.003).IL-6 (1.09, 0.94–1.25), TNF- α (1.65, 0.99–2.74), and resistin (1.28, 0.78–2.11) was not associated with risk of cancer. By cancer site and type, highest category of adiponectin was associated with decreased risk of breast (OR 0.74, 0.60-0.91), colorectal (0.74, 0.60–0.91), and endometrial cancer (0.49, 0.34–0.72). Higher leptin was associated with increased risk of endometrial (1.88, 1.24–2.87) and kidney cancer (2.07, 1.51–2.83).ConclusionOur study suggests that adiponectin and leptin may play a role in the etiology of cancer.     

Relation of visfatin to cardiovascular risk factors and adipocytokines in patients with impaired fasting glucose

ObjectiveThe discovery of visfatin has great potential to significantly enhance our understanding of impaired fasting glucose and diabetes mellitus. The aim of the present study was to explore the relation of visfatin concentrations to cardiovascular risk factors and serum adipocytokine concentrations in patients with impaired fasting glucose.MethodsA sample of 55 patients with impaired fasting glucose was analyzed in a prospective way. All patients with a 2-wk weight-stabilization period before recruitment were enrolled. Weight, blood pressure, basal glucose, lipoprotein(a), C-reactive protein, insulin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triacylglycerols, blood, and adipocytokines (visfatin, leptin, adiponectin, resistin, tumor necrosis factor-α [TNF-α], and interleukin-6) levels were measured. Tetrapolar impedancometry, indirect calorimetry, and prospective serial assessment of nutritional intake with 3-d written food records were performed.ResultsFourteen men (25.5%) and 41 women (74.5%), with a mean age of 57.3 ± 11.7 y and mean body mass index of 35.8 ± 3.6 kg/m², were included. Patients were divided in two groups by median visfatin value (18.2 ng/mL): group I had low values and group II had high values. Patients in group I had greater weight, body mass index, fat mass, fat-free mass, and adiponectin than patients in group II. Patients in group II had higher total cholesterol, low-density lipoprotein cholesterol, resistin, and TNF-α levels than patients in group I. In the multivariate analysis with age- and sex-adjusted basal visfatin concentration as a dependent variable, only TNF-α remained an independent predictor in the model (F = 8.4, P < 0.05), with an inverse correlation. Visfatin concentration decreased 7.33 ng/mL (95% confidence interval 2.10–12.58) for each nanogram per milligram of TNF-α increase.ConclusionOnly TNF-α is related in an independent way to serum visfatin levels.     

Rubella antibodies in vertically and horizontally HIV-infected young adults vaccinated early in life and response to a booster dose in those with seronegative results

BackgroundVery limited data are available on the persistence of rubella antibodies in vertically HIV-infected individuals who were vaccinated early in life.MethodsProspective, cohort study on 4 groups of patients: 96 vertically HIV-1-infected individuals (v-HIV), 69 horizontally HIV-1-infected individuals (h-HIV), 93 healthy controls previously vaccinated for rubella (vac-CON) and 20 healthy controls with history of rubella disease (dis-CON). A blood sample was collected and rubella antibodies were analyzed by ELISA. Rubella antibodies above 10 IU/mL were considered protective. Individuals with seronegative results were offered an extra MMR vaccine dose and were tested at least 30 days afterwards.ResultsTime since previous rubella vaccination was similar in v-HIV, h-HIV and vac-CON (16, 11 and 11 years; p = 0.428). v-HIV and h-HIV were also comparable regarding median CD4 T cells (613 and 614 cells/mm³; p = 0.599) and percentage on ART (93.8% and 98.6%; p = 0.135) at study entry. v-HIV had less individuals on virological suppression (63.5%) compared to 85.5% in h-HIV (p < 0.001). Rubella seropositivity and antibodies were significantly lower in v-HIV compared to h-HIV (32.3% vs 65.5%, 4.3 IU/mL vs 21.1 IU/mL; p < 0.001). Time interval between the last rubella vaccine dose and study entry was associated with an increase of rubella seronegativity, with a 7% higher chance of seronegativity for each one-year increase. After an extra MMR dose, 40 out of 48 (83.3%) seronegative individuals responded, with no significant difference among groups considering rubella seropositivity and antibody levels.ConclusionAs vertically HIV-infected individuals reach adolescence and adulthood, assessment of vaccine antibodies can identify those who might benefit from an extra vaccine dose.     

COVID-19 vaccination coverage in patients with chronic obstructive pulmonary disease – A cross-sectional study in Hungary

IntroductionCoronavirus infection is a particular risk for patients with chronic obstructive pulmonary disease (COPD), because they are much more likely to become severely ill due to oxygen supply problems. Primary prevention, including COVID-19 vaccination is of paramount importance in this disease group. The aim of our study was to assess COVID-19 vaccination coverage in COPD patients during the first vaccination campaign of the COVID-19 pandemic.MethodsA cross-sectional observational study (CHANCE) has been conducted in COPD patients in the eastern, western and central regions of Hungary from 15th November 2021. The anthropometric, respiratory function test results and vaccination status of 1,511 randomly selected patients were recorded who were aged 35 years and older.ResultsThe median age was 67 (61–72) years, for men: 67 (62–73) and for women: 66 (60–72) years, with 47.98 % men and 52.02 % women in our sample. The prevalence of vaccination coverage for the first COVID-19 vaccine dose was 88.62 %, whereas 86.57 % of the patients received the second vaccine dose. When unvaccinated (n = 172) and double vaccinated (n = 1308) patients were compared, the difference was significant both in quality of life (CAT: 17 (12–23) vs 14 (10–19); p < 0.001) and severity of dyspnea (mMRC: 2 (2–2) vs 2 (1–2); p = 0.048). The COVID-19 infection rate between double vaccinated and unvaccinated patients was 1.61 % vs 22.67 %; p < 0.001 six months after vaccination. The difference between unvaccinated and vaccinated patients was significant (8.14 % vs 0.08 %; p < 0.001) among those with acute COVID-19 infection hospitalized. In terms of post-COVID symptoms, single or double vaccinated patients had significantly fewer outpatient hospital admissions than unvaccinated patients (7.56 vs 0 %; p < 0.001).ConclusionThe COVID-19 vaccination coverage was satisfactory in our sample. The uptake of COVID-19 vaccines by patients with COPD is of utmost importance because they are much more likely to develop severe complications.     

Complementary medicine use and flu vaccination – A nationally representative survey of US adults

BackgroundPrior research presented inconsistent results with less, equal or higher vaccination rates among patients using complementary medicine. Given that complementary medicine includes a wide range of therapies, variable vaccination patterns may occur within consultations with different professions. This analysis aims to to evaluate differences between categories of complementary medicine regarding vaccination behavior among US adults.Methods and resultsThis analysis used data from the 2017 National Health Interview Survey (NHIS; n = 26,742; response rate 80.7%). Prevalences of flu vaccination, consultations with complementary medicine practitioners in the past 12 months and their potential interactions were examined. 42.7% of participants had received flu vaccination in the past 12 months, 32.4% had seen one or more complementary medicine practitioner. Users of any type of complementary medicine were as likely as non-users to have received a flu vaccination (44.8% users versus 41.7% non-users; p = 0,862; adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI] = 0.95–1.07). Regarding specific complementary medicine types, individuals consulting with naturopaths (p < 0.001; AOR = 0.67, 95 %CI = 0.54–0.82), homeopaths (p < 0.001; AOR = 0.55; 95 %CI = 0.44–0.69) and chiropractors (p = 0.016; AOR = 0.9, 95 %CI = 0.83–0.98) were less likely, while other complementary medicine approaches showed no significant association with flu vaccination behavior. Independent predictors for a flu shot were prior diabetes, cancer, current asthma, kidney disease, overweight and current pregnancy. As well, higher educational level, age, ethnicity, health insurance coverage and having seen a general physician or medical specialist in the past 12 months were also associated with a higher vaccination rate.ConclusionsComplementary medicine users were equally likely to receive an influenza vaccination compared with non-users. Different complementary therapies showed varied associations with vaccination behavior. Further analyses may be needed to distinguish influencing factors among patients’ vaccination behavior.     

Tdap booster to adolescents with juvenile idiopathic arthritis on and off anti-TNF agents is safe and immunogenic

Introduction: The response to vaccines in juvenile idiopathic arthritis (JIA) patients on and off anti-tumor necrosis factor (anti-TNF) agents remains highly discussed. There are no published studies on the immune response following a Tdap booster dose in JIA patients so far.ObjectiveTo evaluate the immune response and safety after a Tdap booster in JIA patients and in healthy adolescents.MethodsNineteen adolescents with JIA according to the ILAR criteria on anti-TNF medication, 19 adolescents with JIA off anti-TNF medication, and 27 healthy adolescents (control group) were compared after a Tdap booster. Adverse events and disease activity were evaluated. Lymphocyte immunophenotyping was performed by flow cytometry. Tetanus, diphtheria and pertussis toxin antibodies were assessed by ELISA; whole blood was stimulated with whole-cell pertussis, and supernatants were assessed for cytokines by xMAP.ResultsThe three groups showed a similar frequency of adverse events. There was no disease reactivation after the Tdap booster. Tetanus, diphtheria and pertussis antibodies showed a significant response when D0 and D14 concentrations were compared in both JIA groups and controls. Over time, a different pattern of response to the Tdap booster was observed among the groups for tetanus antibodies (p = 0.005) but not for diphtheria and pertussis antibodies. In contrast to the protection attained for tetanus and diphtheria, in the three groups, not all individuals showed pertussis seroconversion at either D14 or D28. In addition, the seroconversion of three subjects with JIA on anti-TNF medication was not maintained at D28. JIA patients off anti-TNF showed a higher percentage of naive CD8 + T cells (p = 0.007) and central memory CD8 + cells (p = 0.003) and a lower percentage of effector CD8 + T cells (p = 0.003) and NK cell numbers (p = 0.018) than the control group. The JIA group off anti-TNF medication had fewer B lymphocytes than both the JIA group on anti-TNF medication and the control group (p = 0.016). Cellular immunity to Bordetella pertussis showed that IFNγ levels were significantly lower in both JIA groups than in the control group (p = 0.003), IL10 levels were higher in the JIA off anti-TNF group (p = 0.009), IL17A and IL5 levels were lower in the JIA on anti-TNF group than in the control group (p = 0.018 and p = 0.016, respectively); however, an increase in IFNγ (p = 0.008), IL17A (p = 0.030) and TNFα (p = 0.041) levels was observed at D14 in both patient groups. Both JIA groups showed higher levels of IL21 than the control group (p = 0.023).ConclusionWe conclude that individuals with JIA on or off anti-TNF agents showed a good response to a booster dose for the three antigens studied in the absence of major adverse events and without the reactivation of the disease.     

Dynamic weight status changes and peer lifestyles in early adolescence: A social network analysis on a longitudinal cohort of Taiwanese youth

BackgroundFriendship networks are relevant to adolescent weight status and lifestyle, but little is known about their relationship in an East Asian setting. Using a longitudinal cohort of Taiwanese adolescents, we studied how weight status and lifestyles might influence friendship. Simultaneously considering the influence of friendship networks, we further examined the effects of peers’ lifestyles on the body weight status of adolescents.MethodsData were retrieved from the first three waves of the Taiwan Youth Project (N = 2409; 51 % boys). Participants were asked to nominate their friends at school and to report their lifestyle factors (e.g. sleep habits, internet use, and athletic performance). Weight status was proxied by body mass index calculated from self-reported weight and height. Stochastic actor-based modeling was used for the friendship network analyses.ResultsConsidering network structure, adolescents selected friends based on similarities in weight status (β = 0.147 [standard error = 0.044], p < 0.001) and lifestyle factors, such as athletic performance (β = 0.181 [0.034], p < 0.001), internet use (β = 0.156 [0.039], p < 0.001), and social jetlag (β = 0.055 [ ± 0.022], p < 0.05). In the behavior dynamics model, we did not observe any peer influence on changes in adolescents’ weight status.ConclusionThese findings suggest a pervasive homophilic friendship selection explained by weight and lifestyle-based similarities, despite no evidence of peer influence on weight status. Stakeholders and care providers of adolescent health should be aware of the social network processes that underlie weight problems.     

A detailed analysis of possible efficacy signals of NTHi-Mcat vaccine against severe COPD exacerbations in a previously reported randomised phase 2b trial

BackgroundAn investigational vaccine containing non-typeable Haemophilus influenzae (NTHi) and Moraxella catarrhalis (Mcat) surface proteins did not show vaccine efficacy (VE) against combined moderate and severe (moderate/severe) exacerbations in a randomised, observer-blinded, placebo-controlled phase 2b trial of patients with chronic obstructive pulmonary disease (COPD). Nevertheless, observations on rates of severe exacerbations and hospitalisations encouraged further evaluation.MethodsPatients with stable COPD (moderate to very severe airflow limitation, Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 2–4), 40–80 years and at least one moderate/severe exacerbation in the last year received two doses of NTHi-Mcat vaccine or placebo plus standard care. Secondary analyses were conducted on VE against exacerbations according to severity. Potential predictive factors at baseline for VE against severe exacerbations were explored in post-hoc analyses.ResultsOf 606 patients enrolled, 571 were included in the efficacy analysis (279 in NTHi-Mcat vaccine group, 292 in placebo group). VE against severe acute exacerbations of COPD (AECOPD) in various subgroups was 52.11 % (p = 0.015; frequent exacerbators), 65.43 % (p = 0.015; baseline GOLD grade 4), 38.24 % (p = 0.034; previous pneumococcal and/or influenza vaccination). VE was 52.49 % (p = 0.044) for the 6–12 months period after 1 month post-dose 2. Multivariable analysis identified two factors (frequent exacerbator status plus inhaled corticosteroid use at baseline) associated with significant VE against severe AECOPD; in this subpopulation, VE was 74.99 % (p < 0.001).ConclusionResults suggest potential efficacy with the NTHi-Mcat vaccine against severe exacerbations in certain patients with COPD, in particular those who have frequent exacerbations and use inhaled corticosteroids. This potential signal requires confirmation in an appropriately designed prospective clinical trial.Trial registrationClinicalTrials.gov, NCT03281876.     

Impacts of Catch-Up Immunization program with the 13-Valent pneumococcal Conjugate vaccine in Taiwan: Focus on age-stratified differences and high-risk population (2001–2015)

BackgroundTaiwan commenced a national catch-up immunization program with a 13-valent pneumococcal conjugate vaccine (PCV13) in 2013 for children aged 2–5 years old and in 2014 for children aged 1–5 years old. However, real-world nationwide evidence of both the direct protection and indirect protection of all-cause pneumonia and pneumococcal pneumonia has been scarce, especially among high-risk populations, defined as patients with chronic diseases or immunosuppression. The aim of this study was to examine the impact of the national PCV13 catch-up program on all-cause pneumonia and pneumococcal pneumonia among overall and high-risk populations using interrupted time series analysis.MethodsUsing the National Health Insurance Research Database (NHIRD) from January 2001 to December 2015, we assessed the impact of this catch-up program by interrupted time-series analyses age-stratified (0–1, 2–4, 5–9, 10–17, 18–34, 35–49, 50–64, 65 + years old) incidence of pneumococcal pneumonia and all-cause pneumonia (100,000 person-quarter) among the overall and high-risk populations.ResultsThe impact of this program was most profound on the incidence of pneumococcal pneumonia in children aged 2–4 years old (level change ?10.56 per 100,000 person-quarters, p = 0.04; trend change ?2.93, p less than 0.01). Indirect protection among unvaccinated children (0–1 years old: trend change ?1.19, p = 0.01; 5–9 years old: trend change ?1.04, p = 0.03; 10–17 years old: level change ?1.42 per 100,000 person-quarters, p = 0.03) was also found. The incidence of all-cause pneumonia also decreased in children aged 2–4 (level change ?234.91 per 100,000 person-quarter, p = 0.058) and 5–9 years old (level change ?173.96 per 100,000 person-quarter, p = 0.0424). However, we did not find a significant impact among most high-risk populations.ConclusionsOur study suggests that the introduction of this catch-up program with PCV13 was associated with significant declines in the incidence of pneumococcal pneumonia and all-cause pneumonia in vaccinated children, and indirect protection from the program was also found in unvaccinated children.