Search

Obesity is becoming a global health problem. Visceral adiposity is the main cause of metabolic and cardiovascular diseases. Dietary improvement is the key to controlling obesity. We hypothesized that a higher Composite Dietary Antioxidant Index (CDAI) was associated with a lower visceral adipose tissue (VAT) area. In this cross-sectional study, 10,389 adults were selected from the National Health and Nutrition Examination Survey 2011–2018. CDAI was calculated based on 6 micronutrients: zinc, selenium, total carotenoids, vitamin A, vitamin C, and vitamin E. VAT area was determined by the dual-energy X-ray absorptiometry scan. Linear regression models were constructed to evaluate the association between CDAI and VAT area. Subgroup analyses were also performed. The mean age of participants was 39.68 years, 5240 were male, and 3841 of those were non-Hispanic White. The inverse associations were observed in all models. In model 3, CDAI was inversely associated with VAT area as a continuous variable, β (95% confidence interval), –0.56 (–0.85 to –0.27). When compared with the first tertile, the third tertile of CDAI was also inversely associated with VAT area, β (95% confidence interval), –6.72 (–10.44 to –2.99). No interactions were found in the subgroup analyses. In conclusion, an inverse association between CDAI and VAT area was found among U.S. adults aged 20 to 59 years. These results suggest the possible benefit of an antioxidant diet in relieving visceral obesity. More prospective studies are needed to identify this dietary benefit. In this cross-sectional study, a higher CDAI consisting of Vitamins A, C, and E, and zinc, selenium, and carotenoid was found to be negatively associated with visceral adipose tissue in U.S. adults.Abbreviation: CDAI, Composite Dietary Antioxidant Index. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: The association between segmental body composition and bone mineral density (BMD) remains uncertain. The primary aim of this cross-sectional investigation was to elucidate the connection between segmental body composition and BMD within the United States adult population. Methods: We selected a cohort of 10,096 individuals from the National Health and Nutrition Examination Survey (NHANES) database, with a mean age of 39 years and a mean BMI of 28.5 kg/m². The parameter of segmental body composition was achieved by quantifying body fat and lean mass percentages across various anatomical regions, including the torso, Android, Gynoid, arms and legs. We conducted a weighted multivariate linear regression analysis to investigate the association between segmental body composition and total BMD. Additionally, subgroup analysis was performed based on age and gender. Results: We found an inverse association between fat proportion in each anatomical region and total BMD, with the arm and leg regions demonstrating the most significant negative correlation. Conversely, a positive correlation was observed between lean mass and BMD across all anatomical regions. These associations remained consistent in subgroup analyses. Conclusion: Our investigation revealed a negative association between adipose levels in various anatomical regions and BMD among Americans aged 20 to 59. Importantly, higher fat proportion in the extremities exerted the most deleterious impact on BMD. Furthermore, an increase in lean mass within each anatomical region was ascertained to confer a positive effect on bone health. Consequently, the evaluation of segmental body composition is well-positioned to predict bone health status. [ABSTRACT FROM AUTHOR]

Objective: Neurocognitive impairment (NCI) is a well-known complication of human immunodeficiency virus (HIV) infection and may be influenced by a number of psychological factors. We examined the relationship between NCI and mental health disorders, including posttraumatic stress disorder (PTSD), in a cohort of 189 active-duty and retired U.S. military men living with HIV. Methods: Participants completed selected modules of the Composite International Diagnostic Interview (CIDI) to ascertain the presence of PTSD, major depressive disorder, and other mental health diagnoses. We also obtained demographic data, including history of head trauma, via personal interview. NCI was assessed with a comprehensive battery of standardized neuropsychological tests. Results: The median age of study subjects was 36 years (interquartile range [IQR] 28 to 43) and median total years of education was 14 (IQR 12 to 16). NCI was diagnosed in 19% of subjects. Individuals with and without a history of PTSD were similar with respect to most HIV-related characteristics; however, the former were significantly more likely to have a prior acquired immunodeficiency syndrome (AIDS) diagnosis. In multivariate analysis, lifetime history of PTSD was independently associated with NCI (odds ration [OR] = 6.12; 95% confidence interval [CI] = 1.85, 20.27), while a history of head of trauma was negatively associated (OR = 0.37 95% CI = 0.15,0.92). Conclusions: Our findings demonstrate that PTSD is an important predictor of NCI in this U.S. military cohort. HIV-infected individuals with cognitive difficulties should be screened for mental health disorders, including PTSD, and prospective studies of the longitudinal relationship between PTSD and NCI, as well as the impact of PTSD treatment on future NCI, are warranted. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the incidence and risk factors of herpes zoster (HZ) in the general U.S. population using data from the U.S. Military HIV Natural History Study (NHS). Topics discussed include comparison of participants with and without HZ, independent predictors of HZ, and factors associated with HZ in NHS participants who contributed follow-up time after 2001.

This study sought to assess the frequency of refractive surgery complications in HIV+ individuals and related risk factors. Multiple centers in the United States. Prospective observational cohort study. The U.S. Military HIV Natural History Study is a prospective observational cohort study of HIV+ service members and beneficiaries. Participants were selected who had Current Procedural Terminology codes for laser in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), and other refractive surgeries. The frequency of complications was determined using International Classification of Diseases-9 codes. Covariates included age, sex, antiretroviral therapy, time since HIV diagnosis, history of AIDS, and CD4 (T lymphocytes) count and viral load. Statistical analysis was completed using univariate (χ2 and Wilcoxon-Mann-Whitney tests) and multivariate analyses. Seventy-nine of 2073 participants had refractive surgery. Fifty-three patients underwent PRK, 23 LASIK, 2 radial keratotomy (RK), and 1 astigmatic correction. Complications occurred in 6 (7.6%) of 79 participants, including 5 patients who underwent PRK and 1 after RK, occurring between 8 and 217 days after surgery. Five ulcers and 1 unspecified keratitis were noted. In the univariate analysis, type of surgery (P =.02) and history of AIDS (P =.02) were risk factors for complications. In logistic regression analysis, no variables were found to be risk factors for complications. Complications were infrequent among HIV+ participants after refractive surgery. Point estimates suggest that PRK might have more complications than LASIK and that advanced HIV, reflected by previous AIDS, might be associated with an increased risk for complications. Further study will be required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Excessive visceral adipose tissue (VAT) is associated with a spectrum of diseases, including diabetes, cancer, and cardiovascular diseases. Remnant cholesterol (RC), denoting cholesterol within triglyceride-rich lipoproteins and their metabolic byproducts, has been identified as a key contributor to cardiovascular diseases and related mortality. However, the association between the VAT and RC remains unclear. In this study, the objective is to provide new evidence regarding the association between VAT and RC concentrations., Methods: 4727 individuals aged 18-59 were selected from the National Health and Nutrition Examination Survey conducted between 2011 and 2018 as study participants. This study utilized several weighted linear regression models and a restricted cubic spline (RCS) to explore the association and potential nonlinearities between VAT and RC. Subgroup analyses were performed to determine the consistency of findings., Results: The mean VAT value was 103.82 ± 1.42 cm 2 , and the median RC value was 18 mg/dl. VAT demonstrated a positive association with RC in a fully adjusted model, with a β and 95% confidence interval (CI) of 0.09 (0.08, 0.11) after adjustment for potential confounders. Analysis using RCS revealed a nonlinear association between the VAT area and RC (P < 0.001 for nonlinearity). Adjusted two-piecewise regression models demonstrated β coefficients of 0.13 (95%CI: 0.11 ~ 0.16, P < 0.001) for RC in individuals with VAT < 143 cm 2 , and 0.02 (95%CI: -0.01 ~ 0.06, P = 0.15) for those with VAT ≥ 143 cm 2 . Interactions were observed among the body mass index (BMI) subgroup; the β coefficients for RC were 0.14 (95%CI: 0.12 ~ 0.16) in those with BMI < 30 kg/m 2 and 0.05 (95%CI:0.04 ~ 0.07) in those with BMI ≥ 30 kg/m 2 , with a P-value of < 0.001 for interaction., Conclusions: This study identified a nonlinear association between VAT and RC in American adults. Reducing the VAT area may be beneficial in lowering RC concentration, particularly when VAT is < 143 cm 2 and those with a BMI < 30 kg/m 2 ., (© 2024. The Author(s).)

Objectives-This report examines changes in telemedicine use among U.S. adults between 2021 and 2022 by selected sociodemographic and geographic characteristics. Methods-Data from the 2021 and 2022 National Health Interview Survey were used to assess changes between these 2 years in the percentage of adults who used telemedicine in the previous 12 months, by sex, age, race and Hispanic origin, family income, education, region of residence, urbanization level, and health insurance coverage. Results-Overall, the percentage of adults who used telemedicine in the past 12 months decreased from 37.0% in 2021 to 30.1% in 2022. This pattern was observed across several sociodemographic and geographic characteristics, such as sex, family income, education, region, and urbanization level. Women, adults with a college degree or higher, and adults living in more urban areas were all more likely to use telemedicine in 2022. In 2021 and 2022, uninsured adults ages 18-64 were less likely to use telemedicine compared with those who had private or public insurance, while adults age 65 and older who had Medicare only were less likely to use telemedicine compared with those with other types of insurance. However, for both age groups, telemedicine use decreased from 2021 to 2022 for all insurance types except public coverage for adults ages 18-64. Summary-National Health Interview Survey data may be used to monitor national trends and understand patterns of telemedicine use by sociodemographic and geographic characteristics as the transition forward from the global COVID-19 pandemic continues., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

Injuries can have physical (1), psychological (2,3), and economic (4) consequences, including problems with wound repair and persistent pain. Additionally, the consequences of injury may interfere with normal activities and return to work (1). This report describes the percentage of adults who had an injury that limited their usual activities in the past 3 months (an activitylimiting injury) by selected sociodemographic characteristics from the 2020 and 2021 National Health Interview Survey (NHIS)., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

A significant minority of people living with HIV (PLWH) achieve viral suppression (VS) on antiretroviral therapy (ART) but do not regain healthy CD4 counts. Clinical factors affecting this immune non-response (INR) and its effect on incident serious non-AIDS events (SNAEs) have been challenging to understand due to confounders that are difficult to control in many study settings. The U.S. Military HIV Natural History Study (NHS) and African Cohort Study (AFRICOS). PLWH with sustained VS (< 400 copies/ml for at least two years) were evaluated for INR (CD4 < 350 cells/µl at the time of sustained VS). Logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with INR. Cox proportional hazards regression produced adjusted hazard ratios (aHRs) for factors associated with incident SNAE after sustained VS. INR prevalence was 10.8% and 25.8% in NHS and AFRICOS, respectively. Higher CD4 nadir was associated with decreased odds of INR (aOR = 0.34 [95% CI 0.29, 0.40] and aOR = 0.48 [95% CI 0.40, 0.57] per 100 cells/µl in NHS and AFRICOS, respectively). After adjustment, INR was associated with a 61% increase in relative risk of SNAE [95% CI 1.12, 2.33]. Probability of "SNAE-free" survival at 15 years since sustained VS was approximately 20% lower comparing those with and without INR; nearly equal to the differences observed by 15-year age groups. CD4 monitoring before and after VS is achieved can help identify PLWH at risk for INR. INR may be a useful clinical indicator of future risk for SNAEs., (© 2022. The Author(s).)

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included ( n  = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.

Background: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research., Methods: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion., Results: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder., Conclusions: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities., Competing Interests: Conflict of interest: C. Bai has nothing to disclose. Conflict of interest: S.H. Chotirmall has nothing to disclose. Conflict of interest: J. Rello has nothing to disclose. Conflict of interest: G.A. Alba has nothing to disclose. Conflict of interest: L.C. Ginns has nothing to disclose. Conflict of interest: J.A. Krishnan reports grants from National Institutes of Health, Regeneron/Department of Health and Human Services, and Verily for COVID-19 studies outside the submitted work. Conflict of interest: R. Rogers has nothing to disclose. Conflict of interest: E. Bendstrup reports grants and personal fees from Hofmann la Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: P-R. Burgel reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Insmed, Novartis, Pfizer, Teva and Zambon, and grants and personal fees from Vertex and GSK, outside the submitted work. Conflict of interest: J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Glaxosmithkline, Insmed and Novartis, personal fees from Chiesi and Zambon, and grants from Gilead, outside the submitted work. Conflict of interest: A. Chua has nothing to disclose. Conflict of interest: K.A. Crothers has nothing to disclose. Conflict of interest: A. Duggal has nothing to disclose. Conflict of interest: Y.W. Kim has nothing to disclose. Conflict of interest: J.G. Laffey has nothing to disclose. Conflict of interest: C.M. Luna has nothing to disclose. Conflict of interest: M.S. Niederman reports other funding from Abbvie and Merck, outside the submitted work. Conflict of interest: G. Raghu reports consultant fees from Boerhinger Ingelheim, Roche-Genentech, Blade therapeutics, PureTech Health and Humanetics corporation. Conflict of interest: J.A. Ramirez has nothing to disclose. Conflict of interest: J. Riera has nothing to disclose. Conflict of interest: O. Roca provides consultancy to Hamilton Medical but did not receive any personal fees. All compensations were received by the Institute of Research of his institution. He also reports personal fees from Air Liquide, outside the submitted work. Conflict of interest: M. Tamae-Kakazu has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose. Conflict of interest: R.R. Watkins has nothing to disclose. Conflict of interest: M. Barrecheguren reports speaker fees from Grifols, Menarini, CSL Behring, Boehringer Ingelheim and GSK, and consulting fees from GSK and Novartis, outside the submitted work. Conflict of interest: M. Belliato has nothing to disclose. Conflict of interest: H.A. Chami reports grants, personal fees and non-financial support from Pfizer, and personal fees from Boehringer Ingelheim, MSD, Novartis, Mundipharma and AstraZeneca, outside the submitted work. Conflict of interest: R. Chen has nothing to disclose. Conflict of interest: G.A. Cortes Puentes has nothing to disclose. Conflict of interest: C. Delacruz has nothing to disclose. Conflict of interest: M.M. Hayes has nothing to disclose. Conflict of interest: L.M.A. Heunks reports grants from Liberate medical, USA, personal fees from Getinge Critical Care, Sweden, and grants and personal fees from Orion Pharma, Finland, outside the submitted work. Conflict of interest: S.R. Holets has nothing to disclose. Conflict of interest: C.L. Hough has nothing to disclose. Conflict of interest: S. Jagpal was a sub-investigator for the RWJ New Brunswick Remdesivir study. Conflict of interest: S. Jeon has nothing to disclose. Conflict of interest: K. Johkoh has nothing to disclose. Conflict of interest: M.M. Lee has nothing to disclose. Conflict of interest: J. Liebler has nothing to disclose. Conflict of interest: G.N. McElvaney has nothing to disclose. Conflict of interest: A. Moskowitz has nothing to disclose. Conflict of interest: R.A. Oeckler has nothing to disclose. Conflict of interest: I. Ojanguren reports grants and personal fees from AstraZeneca and Chiesi, personal fees from Boehringer Ingelheim, Novartis, GSK, MSD, BIAL, Mundipharma and TEVA, and grants from Menarini, outside the submitted work. Conflict of interest: A. O'Regan has nothing to disclose. Conflict of interest: M.W. Pletz has nothing to disclose. Conflict of interest: C.K. Rhee reports personal fees from MSD, AstraZeneca, GSK Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, Teva, Sanofi and Bayer, outside the submitted work. Conflict of interest: M.J. Schultz's institution and department participated, and participates in, international studies of remdisivir. Participation was without financial compensations, etc., and also did not and will not lead to authorships on manuscripts from these studies. Conflict of interest: E. Storti has nothing to disclose. Conflict of interest: C. Strange has nothing to disclose. Conflict of interest: C.C. Thomson has nothing to disclose. Conflict of interest: F.J. Torriani has nothing to disclose. Conflict of interest: X. Wang has nothing to disclose. Conflict of interest: W. Wuyts has nothing to disclose. Conflict of interest: T. Xu has nothing to disclose. Conflict of interest: D. Yang has nothing to disclose. Conflict of interest: Z. Zhang has nothing to disclose. Conflict of interest: K.C. Wilson has nothing to disclose., (Copyright ©ERS 2020.)

Background: Sexually transmitted infections have historically been burdensome in military populations. We describe the seroprevalence and seroincidence of vaccine-preventable human papillomavirus (VP-HPV) subtypes in a sample of 200 servicemen, along with the seroprevalence and seroincidence of herpes simplex virus (HSV-1/2) and syphilis in a sample of 200 men and 200 women., Methods: Sera from 200 men, along with associated demographic data, were obtained and tested for HPV serotypes at service entry and 10 years later. Similarly, 200 active-duty men and 200 active-duty women were tested for HSV-1/2 at entry to service and 4 years later., Results: The baseline prevalence of VP-HPV subtypes was 14.5%, and cumulative seroincidence of new infection was 34% over a 10-year period (n = 68). Of these, 63% (n = 43) represented HPV-6, HPV-11, or both; 18% of new infections were either HPV-16 or HPV-18, and 19% (n = 13) were a mixture of all 4 strains. At entry to military service, 33.5% of men were seropositive for HSV-1 and 1.5% were positive for HSV-2; seroincidence was 3.4 and 1.1 per 100 person-years, respectively. Among women, 39% were seropositive for HSV-1 and 4.0% for HSV-2; seroincidence was 5.5 and 3.3 per 100 person-years, respectively. There were 2 prevalent and 3 incident cases of syphilis., Conclusions: Sexually transmitted infections in military populations are highly prevalent, incident, and epidemiologically distinct. Our data show the rates of HPV and HSV-1/2 acquisition that are higher than those seen in the general public, again highlighting the need for continued preventive efforts. Consideration of universal HPV vaccination among men is warranted.

Vaccination against human papillomavirus (HPV) is recommended to prevent cervical cancer among women. Vaccinating men against human papillomavirus (HPV) can prevent penile, anal, and oral cancers, anogenital warts, and the transmission of HPV to their sexual partners. This study characterized HPV acquisition among male military members by evaluating both seroprevalence at entry into service and seroincidence of HPV infection after ten years of service. At entry, 29 of 200 (14.5%) male service members were positive for HPV serotypes 6, 11, 16, or 18. Of 199 initially seronegative for at least one of the four HPV serotypes, 68 (34.2%) seroconverted to one or more serotypes at ten years; more than one-third of these were seropositive for oncogenic HPV serotypes. This estimate of HPV seroprevalence among male military accessions is higher than that reported among U.S. civilian males. Vaccination to prevent genital warts and cancers resulting from HPV infection may decrease health care system burdens. Further analyses are warranted to understand the potential costs and benefits of a policy to vaccinate male service members.