Chikungunya infection in pregnancy - reassuring maternal and perinatal outcomes: a retrospective observational study.

OBJECTIVE: To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). DESIGN: Retrospective observational study. SETTING: Grenada. POPULATION: Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. METHODS: This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. MAIN OUTCOME MEASURES: Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. RESULTS: Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (µ = 898 days, σ = 277 days) compared with infections outside of pregnancy (µ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CONCLUSION: CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. TWEETABLE ABSTRACT: Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.

Prevention of severe clinical signs and pathological lesions of leptospirosis in experimentally challenged dogs

Objective: To prevent severe clinical and pathological findings of leptospirosis in dogs vaccinated against L. interrogans serovar Copenhageni. Design and Methodology: Two vaccination-challenge experiments involving 22 dogs were performed using a vaccine prepared from formalin-killed cultures of L. interrogans serovar Copenhageni. The dogs were challenged by administering a suspension of 1 x 109 of a virulent strain of serovar Copenhageni (8 mL) at 2 weeks (Study 1: Onset of immunity) and 14 months (Study 2: Duration of immunity) after primary and secondary vaccinations. Each dog was observed for clinical signs of leptospirosis for five weeks post-challenge (PC). Any dog which showed irreversible clinical signs of leptospirosis was humanely euthanized, and a necropsy performed. Results: One (20.0 %) vaccinated puppy in Study 1 showed mild clinical signs (PC) which lasted for one day. Five (100.0 %) non-vaccinated (controls) puppies exhibited irreversible signs of acute severe leptospirosis PC, as well as significant postmortem lesions consistent with leptospiral infection. In Study 2, no clinical signs were exhibited by the vaccinated group of dogs PC, while two (40.0 %) non-vaccinated dogs exhibited mild clinical signs for 2 to 3 days, after which they recovered. Conclusions: The vaccine was successful in protecting vaccinated dogs against acute leptospirosis 2 weeks and 14 months after a vaccination schedule of two doses of the bacterin (primary and booster doses), since all vaccinated dogs were clinically normal after challenge with a virulent inoculum of serovar Copenhageni.

Higher Fecal Short-Chain Fatty Acid Levels Are Associated with Gut Microbiome Dysbiosis, Obesity, Hypertension and Cardiometabolic Disease Risk Factors.

Fiber fermentation by gut microbiota yields short-chain fatty acids (SCFAs) that are either absorbed by the gut or excreted in feces. Studies are conflicting as to whether SCFAs are beneficial or detrimental to cardiometabolic health, and how gut microbiota associated with SCFAs is unclear. In this study of 441 community-dwelling adults, we examined associations of fecal SCFAs, gut microbiota diversity and composition, gut permeability, and cardiometabolic outcomes, including obesity and hypertension. We assessed fecal microbiota by 16S rRNA gene sequencing, and SCFA concentrations by gas chromatography/mass spectrometry. Fecal SCFA concentrations were inversely associated with microbiota diversity, and 70 unique microbial taxa were differentially associated with at least one SCFA (acetate, butyrate or propionate). Higher SCFA concentrations were associated with a measure of gut permeability, markers of metabolic dysregulation, obesity and hypertension. Microbial diversity showed association with these outcomes in the opposite direction. Associations were significant after adjusting for measured confounders. In conclusion, higher SCFA excretion was associated with evidence of gut dysbiosis, gut permeability, excess adiposity, and cardiometabolic risk factors. Studies assessing both fecal and circulating SCFAs are needed to test the hypothesis that the association of higher fecal SCFAs with obesity and cardiometabolic dysregulation is due to less efficient SCFA absorption.

HPV Vaccination Recommendation Practices among Adolescent Health Care Providers in 5 Countries.

STUDY OBJECTIVE: To assess adolescent health care providers' recommendations for, and attitudes towards human papillomavirus (HPV) vaccination in 5 countries. DESIGN: In-depth interviews of adolescent health care providers, 2013-2014. SETTING: Five countries where HPV vaccination is at various stages of implementation into national programs: Argentina, Malaysia, South Africa, South Korea, and Spain. PARTICIPANTS: Adolescent health care providers (N = 151) who had administered or overseen provision of adolescent vaccinations (N = Argentina: 30, Malaysia: 30, South Africa: 31, South Korea: 30, Spain: 30). MAIN OUTCOME MEASURES: Frequency of HPV vaccination recommendation, reasons providers do not always recommend the vaccine and facilitators to doing so, comfort level with recommending the vaccine, reasons for any discomfort, and positive and negative aspects of HPV vaccination. RESULTS: Over half of providers 82/151 (54%) recommend HPV vaccination always or most of the time (range: 20% in Malaysia to 90% in Argentina). Most providers 112/151 (74%) said they were comfortable recommending HPV vaccination, although South Korea was an outlier 10/30 (33%). Providers cited protection against cervical cancer 124/151 (83%) and genital warts 56/151 (37%) as benefits of HPV vaccination. When asked about the problems with HPV vaccination, providers mentioned high cost 75/151 (50% overall; range: 26% in South Africa to 77% in South Korea) and vaccination safety 28/151 (19%; range: 7% in South Africa to 33% in Spain). Free, low-cost, or publicly available vaccination 59/151 (39%), and additional data on vaccination safety 52/151 (34%) and efficacy 43/151 (28%) were the most commonly cited facilitators of health provider vaccination recommendation. CONCLUSION: Interventions to increase HPV vaccination should consider a country's specific provider concerns, such as reducing cost and providing information on vaccination safety and efficacy.

Increasing Effectiveness of Messages about Chemicals in Cigarette Smoke.

OBJECTIVES: Federal law requires informing the public on toxic chemicals in cigarette smoke. We sought the public's advice about communicating information about these chemicals. METHODS: Adolescents, young adults, and adults (N = 59), including smokers and non-smokers, participated in 9 focus groups that discussed inclusion of messages about toxic chemicals on cigarette packs, in media campaigns, and on a website. We transcribed, coded, and analyzed focus group audio-recordings. RESULTS: Participants had 3 suggestions for message content to increase the impact of messages about cigarette smoke chemicals. First, they wanted to see messages rotated more frequently to increase message novelty. Second, they recommended using stories and pictures to help connect people to the abstract idea of chemicals in smoke. Third, they cautioned against making messages that might seem overblown and could appeal to the rebellious nature of adolescents. Some participants mentioned that chemical information on a website might discourage people from smoking; others mentioned that people might use it to choose which brand to smoke. CONCLUSIONS: Legislation provides the impetus to design new chemical disclosure messages for cigarette packs and other media. Our findings can help increase the impact of these messages.

Metformin Is Associated With Higher Relative Abundance of Mucin-Degrading Akkermansia muciniphila and Several Short-Chain Fatty Acid-Producing Microbiota in the Gut.

OBJECTIVE: Recent studies suggest the beneficial effects of metformin on glucose metabolism may be microbially mediated. We examined the association of type 2 diabetes, metformin, and gut microbiota in community-dwelling Colombian adults. On the basis of previous research, we hypothesized that metformin is associated with higher levels of short-chain fatty acid (SCFA)-producing and mucin-degrading microbiota. RESEARCH DESIGN AND METHODS: Participants were selected from a larger cohort of 459 participants. The present analyses focus on the 28 participants diagnosed with diabetes-14 taking metformin- and the 84 participants without diabetes who were matched (3-to-1) to participants with diabetes by sex, age, and BMI. We measured demographic information, anthropometry, and blood biochemical parameters and collected fecal samples from which we performed 16S rRNA gene sequencing to analyze the composition and structure of the gut microbiota. RESULTS: We found an association between diabetes and gut microbiota that was modified by metformin use. Compared with participants without diabetes, participants with diabetes taking metformin had higher relative abundance of Akkermansia muciniphila, a microbiota known for mucin degradation, and several gut microbiota known for production of SCFAs, including Butyrivibrio, Bifidobacterium bifidum, Megasphaera, and an operational taxonomic unit of Prevotella. In contrast, compared with participants without diabetes, participants with diabetes not taking metformin had higher relative abundance of Clostridiaceae 02d06 and a distinct operational taxonomic unit of Prevotella and a lower abundance of Enterococcus casseliflavus. CONCLUSIONS: Our results support the hypothesis that metformin shifts gut microbiota composition through the enrichment of mucin-degrading A. muciniphila as well as several SCFA-producing microbiota. Future studies are needed to determine if these shifts mediate metformin's glycemic and anti-inflammatory properties.

Awareness of Cervical Cancer Causes and Predeterminants of Likelihood to Screen Among Women in Haiti.

OBJECTIVES: Cervical cancer is the leading cause of cancer deaths among women in Haiti. Given this high disease burden, we sought to better understand women's knowledge of its causes and the sociodemographic and health correlates of cervical cancer screening. MATERIALS AND METHODS: Participants were 410 adult women presenting at clinics in Léogâne and Port-au-Prince, Haiti. We used bivariate and multivariate logic regression to identify correlates of Pap smear receipt. RESULTS: Only 29% of respondents had heard of human papillomavirus (HPV), whereas 98% were aware of cervical cancer. Of those aware of cervical cancer, 12% believed that sexually transmitted infections (STIs) cause it, and only 4% identified HPV infection as the cause. Women with a previous sexually transmitted infection were more likely to have had Pap smear (34% vs 71%, odds ratio = 3.45; 95% CI = 1.57-7.59). Screening was also more likely among women who were older than the age of 39 years, better educated, and employed (all p < .05). Almost all women (97%) were willing to undergo cervical cancer screening. CONCLUSIONS: This sample of Haitian women had limited awareness of HPV and cervical cancer causes; but when provided with health information, they saw the benefits of cancer screening. Future initiatives should provide health education messages, with efforts targeting young and at-risk women.

Human Papillomavirus Awareness in Haiti: Preparing for a National HPV Vaccination Program.

STUDY OBJECTIVE: Cervical cancer morbidity and mortality are pressing public health issues that affect women in Haiti. To inform efforts to develop a human papillomavirus (HPV) vaccination program in Haiti, we sought to understand HPV awareness and willingness to get HPV vaccination in Haiti. DESIGN, SETTING, AND PARTICIPANTS: We interviewed a convenience sample of 475 women and men in 2 clinical settings in Port-au-Prince and Léogâne, Haiti between April and July 2014. INTERVENTIONS AND MAIN OUTCOME MEASURES: HPV awareness and willingness to get HPV vaccine for daughters. RESULTS: Few participants (27%, 130/475) had heard of HPV. Awareness of HPV was higher among respondents with a previous sexually transmitted infection compared with those without a previous sexually transmitted infection (odds ratio, 2.38; 95% confidence interval, 1.10-5.13). Adults who had heard of genital warts were also more likely to be aware of HPV compared with those who had not (odds ratio, 4.37; 95% confidence interval, 2.59-7.38). Only 10% (24/250) of parents had previously heard of HPV vaccine; however, after researchers explained the purpose of the vaccine, nearly all (96%, 240/250) said they would be willing to get HPV vaccine for their daughters if it were available. CONCLUSION: Despite low awareness of HPV in Haiti, interest in HPV vaccination was nearly universal in our study of health care-seeking adults. This high acceptability suggests that HPV vaccination programs instituted in Haiti would be well received.

Sex-specific associations of low birth weight with adult-onset diabetes and measures of glucose homeostasis: Brazilian Longitudinal Study of Adult Health.

Emerging evidence suggests sex differences in the early origins of adult metabolic disease, but this has been little investigated in developing countries. We investigated sex-specific associations between low birth weight (LBW; <2.5 kg) and adult-onset diabetes in 12,525 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Diabetes was defined by self-reported information and laboratory measurements. In confounder-adjusted analyses, LBW (vs. 2.5-4 kg) was associated with higher prevalence of diabetes in women (Prevalence Ratio (PR) 1.54, 95% CI: 1.32-1.79), not in men (PR 1.06, 95% CI: 0.91-1.25; Pheterogeneity = 0.003). The association was stronger among participants with maternal diabetes (PR 1.60, 95% CI: 1.35-1.91), than those without (PR 1.15, 95% CI: 0.99-1.32; Pheterogeneity = 0.03). When jointly stratified by sex and maternal diabetes, the association was observed for women with (PR 1.77, 95% CI: 1.37-2.29) and without (PR 1.45, 95% CI: 1.20-1.75) maternal diabetes. In contrast, in men, LBW was associated with diabetes in participants with maternal diabetes (PR 1.45, 95% CI: 1.15-1.83), but not in those without (PR 0.92, 95% CI: 0.74-1.14). These sex-specific findings extended to continuous measures of glucose homeostasis. LBW was associated with higher diabetes prevalence in Brazilian women, and in men with maternal diabetes, suggesting sex-specific intrauterine effects on adult metabolic health.

Gestational weight gain and obesity, adiposity and body size in African-American and Dominican children in the Bronx and Northern Manhattan.

Gestational weight gain (GWG) is potentially modifiable and is associated with infant size and body composition; however, long-term effects on childhood obesity have not been reported among multi-ethnic urban populations. We examined the association between GWG and child anthropometric measures and body composition at 7 years [waist circumference (WC), body mass index z-score (BMIZ), obesity (BMIZ ≥95%ile) and bioelectrical impedance analysis estimates of percentage body fat (%fat)] in African-American and Dominican dyads (n = 323) in the Columbia Center for Children's Environmental Health prospective birth cohort study from 1998 to 2013. Linear and logistic regression evaluated associations between excessive GWG [>Institute of Medicine (IOM) 2009 guidelines] and outcomes, adjusting for pre-pregnancy BMI and covariates. Pre-pregnancy BMI (mean ± standard deviation, all such values) and total GWG were 25.8 ± 6.2 kg m(-2) (45% overweight/obese) and 16.4 ± 7.9 kg (64% > IOM guidelines), respectively. Excessive GWG was associated with higher BMIZ {0.44 [95% confidence interval (CI): 0.2, 0.7], P < 0.001}, WC [ß: 2.9 cm (95% CI: 1.1, 4.6), P = 0.002], %fat at 7 years [ß: 2.2% (95% CI: 1.0, 3.5), P = 0.001)] and obesity [odds ratio: 2.93 (95% CI: 1.5, 5.8), P = 0.002]. Pre-pregnancy BMI was positively associated with child size, adiposity and obesity (all P < 0.05). Excessive GWG was highly prevalent and was associated with child obesity, greater percentage body fat and abdominal adiposity. Strategies to support healthy GWG are warranted to promote healthy growth and prevent childhood obesity.

Leg length and type 2 diabetes: what's the link?

PURPOSE OF REVIEW: Human leg length is determined by a complex interplay of genetics and environmental exposures during development, which may be associated with long-term metabolic disease risk. Here, we review recent literature on the link between relative leg length and type 2 diabetes in more and less economically developed societies, wherein the contextual influences on relative leg length are unique. We also hypothesize mechanisms underlying and mediating this association. RECENT FINDINGS: Evidence from more economically prosperous Western populations and contemporary adult populations in China and Brazil indicates that lower relative leg length is associated with greater risk for impaired glucose homeostasis and type 2 diabetes. In Brazil, this association was stronger among women with early menarche. Although still poorly defined and in need of further research, the potential mechanisms likely involve suboptimal early-life net nutrition that simultaneously leads to retarded growth and impaired glucose regulation. An untested hypothesis is that the association is mediated by differences in skeletal muscle mass. SUMMARY: Epidemiologic evidence from diverse settings points to humans with shorter legs relative to their stature having higher risk for type 2 diabetes. Although research is needed to test mechanistic hypotheses, the greatest potential for improving public health will come through identification of, and intervention upon, the upstream modifiable determinants of inadequate leg growth.

Coffee Consumption, Newly Diagnosed Diabetes, and Other Alterations in Glucose Homeostasis: A Cross-Sectional Analysis of the Longitudinal Study of Adult Health (ELSA-Brasil).

INTRODUCTION: Observational studies have reported fairly consistent inverse associations between coffee consumption and risk of type 2 diabetes, but this association has been little investigated with regard to lesser degrees of hyperglycemia and other alterations in glucose homeostasis. Additionally, the association between coffee consumption and diabetes has been rarely investigated in South American populations. We examined the cross-sectional relationships of coffee intake with newly diagnosed diabetes and measures of glucose homeostasis, insulin sensitivity, and insulin secretion, in a large Brazilian cohort of middle-aged and elderly individuals. METHODS: We used baseline data from 12,586 participants of the Longitudinal Study of Adult Health (ELSA-Brasil). Logistic regression analyses were performed to examine associations between coffee consumption and newly diagnosed diabetes. Analysis of covariance was used to assess coffee intake in relation to two-hour glucose from an oral glucose tolerance test, fasting glucose, glycated hemoglobin, fasting and -2-hour postload insulin and measures of insulin sensitivity. RESULTS: We found an inverse association between coffee consumption and newly diagnosed diabetes, after adjusting for multiple covariates [23% and 26% lower odds of diabetes for those consuming coffee 2-3 and >3 times per day, respectively, compared to those reporting never or almost never consuming coffee, (p = .02)]. An inverse association was also found for 2-hour postload glucose [Never/almost never: 7.57 mmol/L, ≤1 time/day: 7.48 mmol/L, 2-3 times/day: 7.22 mmol/L, >3 times/day: 7.12 mol/L, p<0.0001] but not with fasting glucose concentrations (p = 0.07). Coffee was additionally associated with 2-hour postload insulin [Never/almost never: 287.2 pmol/L, ≤1 time/day: 280.1 pmol/L, 2-3 times/day: 275.3 pmol/L, >3 times/day: 262.2 pmol/L, p = 0.0005) but not with fasting insulin concentrations (p = .58). CONCLUSION: Our present study provides further evidence of a protective effect of coffee on risk of adult-onset diabetes. This effect appears to act primarily, if not exclusively, through postprandial, as opposed to fasting, glucose homeostasis.

Socioeconomic status is positively associated with measures of adiposity and insulin resistance, but inversely associated with dyslipidaemia in Colombian children.

BACKGROUND: Low socioeconomic status (SES) has been associated with higher risk of cardiometabolic diseases in developed societies, but investigation of SES and cardiometabolic risk in children in less economically developed populations is sparse. We aimed to examine associations among SES and cardiometabolic risk factors in Colombian children. METHODS: We used data from a population-based study of 1282 children aged 6-10 years from Bucaramanga, Colombia. SES was classified according to household wealth, living conditions and access to public utilities. Anthropometric and biochemical parameters were measured at a clinic visit. Cardiometabolic risk factors were analysed continuously using linear regression and as binary outcomes-according to established paediatric cut points-using logistic regression to calculate OR and 95% CIs. RESULTS: Mean age of the children was 8.4 (SD 1.4) and 51.1% of the sample were boys. Odds of overweight/obesity, abdominal obesity and insulin resistance were greater among higher SES. Compared with the lowest SES stratum, children in the highest SES had higher odds of overweight/obesity (OR=3.25, 95% CI 1.89 to 5.57), abdominal obesity (OR=2.74, 95% CI 1.41 to 5.31) and insulin resistance (OR=2.60, 95% CI 1.81 to 3.71). In contrast, children in the highest SES had lower odds of hypertriglyceridaemia (triglycerides ≥90th centile; OR=0.28, 95% CI 0.14 to 0.54) and low (≤10th centile) high-density lipoprotein (HDL) cholesterol (OR=0.35, 95% CI 0.15 to 0.78). CONCLUSIONS: In Colombian children, SES is directly associated with obesity and insulin resistance, but inversely associated with dyslipidaemia (hypertriglyceridaemia and low HDL cholesterol). Our findings highlight the need to analyse cardiometabolic risk factors separately in children and to carefully consider a population's level of economic development when studying their social determinants of cardiometabolic disease.

Relative leg length is associated with type 2 diabetes differently according to pubertal timing: the Brazilian longitudinal study of adult health.

OBJECTIVES: Studies from developed societies have shown that individuals with short legs relative to height have higher risk of type 2 diabetes. This has been much less explored in less developed populations where influences on relative leg length and diabetes may differ. The Brazilian Longitudinal Study of Adult Health (in Portuguese, ELSA-Brasil) allows us to test, in a cohort born (1934-1975) and raised when undernutrition was common, whether short legs relative to height is positively associated with diabetes, independent of early-life factors, including birth weight, age at menarche, and young-adult BMI. METHODS: We used baseline, cross-sectional data from 15,105 participants aged 35-74 years participating in ELSA-Brasil. We created age-and-sex-specific Z scores for leg length index (leg length/height × 100) according to an external reference. Diabetes was defined by self-reported physician diagnosis, medication use, fasting and 2-h post-75-g-load glucose, and A1C. RESULTS: A one-unit decrement in leg-length-index Z score was associated with 12% (8-17%) higher prevalence of diabetes in Brazilian adults, after adjustment through Poisson regression for confounders, including race, maternal education, and birth weight. This association persisted after further adjustment for menarche age, BMI (at age 20), buttocks circumference, and waist circumference. It was stronger among women with early menarche (P interaction = 0.02). Leg length index was also inversely associated with fasting glucose, fasting insulin, 2-h glucose, and A1C (P < 0.05). CONCLUSIONS: In contemporary Brazilian adults, short legs relative to height is positively associated with diabetes independent of measures of intrauterine growth, pubertal timing, and young-adult adiposity. This association is stronger in women with early menarche.

Overweight and obesity among Grenadian adolescents: rural and urban differences in social determinants

OBJECTIVE: To examine the prevalence of overweight and obesity (OW/OB) among Grenadian adolescents and to determine associations with social determinants on urban and rural adolescents. DESIGN AND METHODS: A national sample of Form1 students (n = 689) aged 11 to 14 years, from all 23 secondary schools in Grenada were assessed as part of the Grenada School Nutrition Study (GSNS). Body Mass Index (BMI) was assessed using standard measures and standardized BMI percentile. Urban (n = 13) and rural (n = 10) schools were determined by location. Exposure to fast food outlets and shops which sold sugar sweetened beverages, candy, or highly processed foods was measured within a .75 km buffer surrounding each school and major transportation hub, between school and home. RESULTS: Overall, Grenadian adolescents had low rates of overweight (17.6%) and obesity (7.6%) compared to Grenadian adults. Girls, however, had nearly twice the rate of overweight compared to boys (i.e., 22.7% versus 12.2%). There were significant differences between rural and urban students for access to cars (40.7% versus 53.3%), computer access (61.6% versus 73.5%), and snacking after school (83.6% versus 90.5%) respectively. The rural school environment also had a lower mean density of snack shops (1.53 versus 3.39 shops/square km) and mean fast food outlet density (0 versus 1.17 outlets/square km). CONCLUSIONS: Grenadian adolescents demonstrate low rates of OW/OB compared to both Grenadian adults and their US counterparts. The low rates of OW/OB suggest Grenadian adolescents have not yet been affected by social determinants of the obesity epidemic.

Individual and school-level influences on moderate and vigorous physical activity in Grenada adolescents

OBJECTIVE: The effect of school level policies on the physical activity of Grenadian children had not been studied. The present study tested the hypothesis that schools with physical activity (PA)-promoting policies would positively impact student’s levels of moderate and vigorous physical activity in Grenada. DESIGN AND METHODS: Multilevel analysis of a nationally representative sample of first year students (i.e. Form 1) (n = 138) from the twenty-three secondary schools in Grenada were assessed as part of the Grenada School Nutrition Study (GSNS). At the individual level physical activity was measured using Actigraph GT3X accelerometers. In addition to socio-demographic measures, height, weight and waist circumference (WC) were collected using standard anthropometric procedures. School-level measures were self-reported by school administrators. The school PA policy index included: student to teacher ratio in physical education (PE) classes, minutes of PE per week, number of PE facilities/equipment, having at least one policy to address PE participation, having ≥1 policy for access to sports teams or activities, having a school board or council to address PE policies. RESULTS: No school-level variables were significantly related to student Moderate and Vigorous Physical Activity (MVPA). Waist circumference was the only variable that significantly predicted MVPA in both boys (p=0.03) and girls (p=0.005). In girls, overweight/obesity was significantly associated with decreased MVPA (p=0.004). CONCLUSIONS: Contrary to findings in United States children, Grenada school-level policies and environments were not related to student’s physical activity levels. Further research was needed to understand the variation in physical activity levels by schools in both male and female Grenada students.

Lessons learnt from the intense 2014 Chikungunya Epidemic in Grenada

OBJECTIVE: To present an overview of the lessons learnt from the fall 2014 outbreak of Chikungunya (CHIK) in Grenada. DESIGN AND METHODS: A review of newspaper articles, news reports and opinions of clinicians and policy makers on the impact and evolution of the CHIK outbreak in Grenada was conducted. RESULTS: CHIK outbreaks on small island developing nations are characterized by high attack rates. The speed of the spread of the virus is facilitated by the efficient domesticated diurnal vector species Aedes aegypti. Efforts to educate the public and to control this vector stretched resources. Clinical attack rates in the Grenada outbreak impacted manpower resources in every sector including clinical services. CONCLUSION: CHILK infected an estimated 60% of the population in just three months of intense transmission. The resulting morbidity meant that essential lessons were learnt. These included the need for a rapid response in educating the population on the mode of transmission of the virus and its prevention, the implementation of vector control and the demand for diagnostic tests. Essential services were short staffed. The need for an unprecedented rapid response and the impact of the CHIK outbreak in Grenada will be presented.

Earlier age at menarche is associated with higher diabetes risk and cardiometabolic disease risk factors in Brazilian adults: Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

OBJECTIVES: Early menarche has been linked to higher risk of type 2 diabetes in Western and Asian societies, yet whether age at menarche is associated with diabetes in Latin America, where puberty and diabetes may have different life courses, is unknown. We tested the hypothesis that earlier menarche is associated with higher diabetes risk in Brazilian adults. METHODS: We used data from 8,075 women aged 35-74 years in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) who had complete information on age at menarche, diabetes status, and covariates. Diabetes was defined based on self-reported physician diagnosis, medication use, and laboratory variables (fasting glucose, 2-hour glucose, and glycated hemoglobin). Poisson regression was used to generate risk ratios (RR) and 95% confidence intervals (CI). RESULTS: Menarche onset < 11 years [vs. 13-14 years (referent)] was associated with higher risk of diabetes (RR = 1.34; 95% CI: 1.14-1.57) after adjusting for sociodemographic factors, maternal education, maternal and paternal diabetes, and birth weight. This persisted after further control for BMI at age 20 years and relative leg length. Additionally, among those not taking diabetes medications, earlier menarche [<11 years vs. 13-14 years (referent)] was associated with higher % glycated hemoglobin (p < 0.001), alanine aminotransferase (p < 0.001), triglycerides (p < 0.001), C-reactive protein (p = 0.003), waist circumference (p < 0.001), and BMI measured at baseline exam (p < 0.001). CONCLUSION: These findings support the hypothesis that earlier menarche is associated with greater risk for adult diabetes and cardiometabolic disease in the Brazilian context.