Risk of COVID-19 Hospitalization and Protection Associated With mRNA Vaccination Among US Adults With Psychiatric Disorders

BACKGROUND

Although psychiatric disorders have been associated with reduced immune responses to other vaccines, it remains unknown whether they influence COVID-19 vaccine effectiveness (VE). This study evaluated risk of COVID-19 hospitalization and estimated mRNA VE stratified by psychiatric disorder status.

METHODS

In a retrospective cohort analysis of the VISION Network in four US states, the rate of laboratory-confirmed COVID-19-associated hospitalization between December 2021 and August 2022 was compared across psychiatric diagnoses and by monovalent mRNA COVID-19 vaccination status using Cox proportional hazards regression.

RESULTS

Among 2,436,999 adults, 22.1% had ≥1 psychiatric disorder. The incidence of COVID-19-associated hospitalization was higher among patients with any versus no psychiatric disorder (394 vs. 156 per 100,000 person-years, p < 0.001). Any psychiatric disorder (adjusted hazard ratio [aHR], 1.27; 95% CI, 1.18-1.37) and mood (aHR, 1.25; 95% CI, 1.15-1.36), anxiety (aHR, 1.33, 95% CI, 1.22-1.45), and psychotic (aHR, 1.41; 95% CI, 1.14-1.74) disorders were each significant independent predictors of hospitalization. Among patients with any psychiatric disorder, aHRs for the association between vaccination and hospitalization were 0.35 (95% CI, 0.25-0.49) after a recent second dose, 0.08 (95% CI, 0.06-0.11) after a recent third dose, and 0.33 (95% CI, 0.17-0.66) after a recent fourth dose, compared to unvaccinated patients. Corresponding VE estimates were 65%, 92%, and 67%, respectively, and were similar among patients with no psychiatric disorder (68%, 92%, and 79%).

CONCLUSION

Psychiatric disorders were associated with increased risk of COVID-19-associated hospitalization. However, mRNA vaccination provided similar protection regardless of psychiatric disorder status, highlighting its benefit for individuals with psychiatric disorders.

Influenza vaccine effectiveness against influenza-A-associated emergency department, urgent care, and hospitalization encounters among U.S. adults, 2022-2023

BACKGROUND

The 2022-2023 United States influenza season had unusually early influenza activity with high hospitalization rates. Vaccine-matched A(H3N2) viruses predominated, with lower levels of A(H1N1)pdm09 activity also observed.

METHODS

Using the test-negative design, we evaluated influenza vaccine effectiveness (VE) during the 2022-2023 season against influenza-A-associated emergency department/urgent care (ED/UC) visits and hospitalizations from October 2022-March 2023 among adults (age ≥18 years) with acute respiratory illness (ARI). VE was estimated by comparing odds of seasonal influenza vaccination among case-patients (influenza A test-positive by molecular assay) and controls (influenza test-negative), applying inverse-propensity-to-be-vaccinated weights.

RESULTS

The analysis included 85,389 ED/UC ARI encounters (17.0% influenza-A-positive; 37.8% vaccinated overall) and 19,751 hospitalizations (9.5% influenza-A-positive; 52.8% vaccinated overall). VE against influenza-A-associated ED/UC encounters was 44% (95% confidence interval [95%CI]: 40-47%) overall and 45% and 41% among adults aged 18-64 and ≥65 years, respectively. VE against influenza-A-associated hospitalizations was 35% (95%CI: 27-43%) overall and 23% and 41% among adults aged 18-64 and ≥65 years, respectively.

CONCLUSIONS

VE was moderate during the 2022-2023 influenza season, a season characterized with increased burden of influenza and co-circulation with other respiratory viruses. Vaccination is likely to substantially reduce morbidity, mortality, and strain on healthcare resources.

Associations of active-duty mental health trajectories with post-military adjustment: Results from the STARRS Longitudinal Study

BACKGROUND

Many servicemembers experience difficulties transitioning from military to civilian life. We examined whether changes in mental health observed during active duty were associated with indices of post-military adjustment.

METHODS

Survey data from the multi-wave Army STARRS Pre/Post Deployment Study (PPDS; conducted 2012-2014) were linked to follow-up data from wave 1 of the STARRS Longitudinal Study (STARRS-LS1; conducted 2016-2018). Empirical Bayes estimates of intercepts and slopes of posttraumatic stress, problematic anger, and depressive symptoms during the PPDS were extracted from mixed-effects growth models and evaluated as predictors of life stress among 1080 participants who had separated or retired from the Army at STARRS-LS1; and of job satisfaction among 586 veterans who were employed at STARRS-LS1.

RESULTS

Higher average levels and larger increases in posttraumatic stress, anger, and depression over the deployment period were each associated with increased stress and (in the case of anger and depression) reduced job satisfaction. Posttraumatic stress and anger slopes were associated with overall stress (b = 5.60, p < 0.01 and b = 15.64, p = 0.04, respectively) and relationship stress (b = 5.50, p = 0.01 and b = 22.86, p = 0.01, respectively) beyond the average levels of those symptoms.

LIMITATIONS

Some transition-related difficulties may have resolved before outcome assessment; some measures were not previously validated.

CONCLUSIONS

Larger increases in posttraumatic stress and anger over a deployment period were associated with increased stress after leaving the Army, even after controlling for average symptom levels during the same period. Monitoring changes in mental health during active duty may help identify personnel who need additional support to facilitate the military-to-civilian transition.

Effectiveness of the Original Monovalent Coronavirus Disease 2019 Vaccines in Preventing Emergency Department or Urgent Care Encounters and Hospitalizations Among Adults With Disabilities: VISION Network, June 2021-September 2022

Adults with disabilities are at increased risk for severe coronavirus disease 2019 (COVID-19). Using data across 9 states during Delta- and Omicron-predominant periods (June 2021-September 2022), we evaluated the effectiveness of the original monovalent COVID-19 messenger RNA vaccines among 521 206 emergency department/urgent care encounters (11 471 [2%] in patients with a documented disability) and 139 548 hospitalizations (16 569 [12%] in patients with a disability) for laboratory-confirmed COVID-19 illness in adults (aged ≥18 years). Across variant periods and for the primary series or booster doses, vaccine effectiveness was similar in those with and those without a disability. These findings highlight the importance of adults with disabilities staying up to date with COVID-19 vaccinations.

Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022

During June-October 2022, the SARS-CoV-2 Omicron BA.5 sublineage accounted for most of the sequenced viral genomes in the United States, with further Omicron sublineage diversification through November 2022.* Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the Omicron BA.4/BA.5 sublineages. On September 1, 2022, a single bivalent booster dose was recommended for adults who had completed a primary vaccination series (with or without subsequent booster doses), with the last dose administered ≥2 months earlier (1). During September 13-November 18, the VISION Network evaluated vaccine effectiveness (VE) of a bivalent mRNA booster dose (after 2, 3, or 4 monovalent doses) compared with 1) no previous vaccination and 2) previous receipt of 2, 3, or 4 monovalent-only mRNA vaccine doses, among immunocompetent adults aged ≥18 years with an emergency department/urgent care (ED/UC) encounter or hospitalization for a COVID-19-like illness.† VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated ED/UC encounters was 56% compared with no vaccination, 32% compared with monovalent vaccination only with last dose 2-4 months earlier, and 50% compared with monovalent vaccination only with last dose ≥11 months earlier. VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated hospitalizations was 59% compared with no vaccination, 42% compared with monovalent vaccination only with last dose 5-7 months earlier, and 48% compared with monovalent vaccination only with last dose ≥11 months earlier. Bivalent vaccines administered after 2, 3, or 4 monovalent doses were effective in preventing medically attended COVID-19 compared with no vaccination and provided additional protection compared with past monovalent vaccination only, with relative protection increasing with time since receipt of the last monovalent dose. All eligible persons should stay up to date with recommended COVID-19 vaccinations, including receiving a bivalent booster dose. Persons should also consider taking additional precautions to avoid respiratory illness this winter season, such as masking in public indoor spaces, especially in areas where COVID-19 community levels are high.

Early Estimates of Bivalent mRNA Vaccine Effectiveness in Preventing COVID-19-Associated Emergency Department or Urgent Care Encounters and Hospitalizations Among Immunocompetent Adults - VISION Network, Nine States, September-November 2022

During June-October 2022, the SARS-CoV-2 Omicron BA.5 sublineage accounted for most of the sequenced viral genomes in the United States, with further Omicron sublineage diversification through November 2022.* Bivalent mRNA vaccines contain an ancestral SARS-CoV-2 strain component plus an updated component of the Omicron BA.4/BA.5 sublineages. On September 1, 2022, a single bivalent booster dose was recommended for adults who had completed a primary vaccination series (with or without subsequent booster doses), with the last dose administered ≥2 months earlier (1). During September 13-November 18, the VISION Network evaluated vaccine effectiveness (VE) of a bivalent mRNA booster dose (after 2, 3, or 4 monovalent doses) compared with 1) no previous vaccination and 2) previous receipt of 2, 3, or 4 monovalent-only mRNA vaccine doses, among immunocompetent adults aged ≥18 years with an emergency department/urgent care (ED/UC) encounter or hospitalization for a COVID-19-like illness.† VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated ED/UC encounters was 56% compared with no vaccination, 31% compared with monovalent vaccination only with last dose 2-4 months earlier, and 50% compared with monovalent vaccination only with last dose ≥11 months earlier. VE of a bivalent booster dose (after 2, 3, or 4 monovalent doses) against COVID-19-associated hospitalizations was 57% compared with no vaccination, 38% compared with monovalent vaccination only with last dose 5-7 months earlier, and 45% compared with monovalent vaccination only with last dose ≥11 months earlier. Bivalent vaccines administered after 2, 3, or 4 monovalent doses were effective in preventing medically attended COVID-19 compared with no vaccination and provided additional protection compared with past monovalent vaccination only, with relative protection increasing with time since receipt of the last monovalent dose. All eligible persons should stay up to date with recommended COVID-19 vaccinations, including receiving a bivalent booster dose. Persons should also consider taking additional precautions to avoid respiratory illness this winter season, such as masking in public indoor spaces, especially in areas where COVID-19 community levels are high.

Is parental socioeconomic status associated with irregularity of energy intake among children?

Background

The timing of eating, chrono-nutrition, is a relatively new research area, where the focus is not on only what we eat but also when we eat and of irregularity between days. Chrono-nutrition have been associated with cardiovascular risk factors among adults. Societal factors influence the chrono-nutrition, but there is limited research on how different socioeconomic factors are associated with chrono-nutrition, especially among children. The aim of this study is to examine the association between parental socioeconomic status and irregularity of children’s energy intake.

Methods

We used data from the DAGIS (Increased Health and Wellbeing in Preschools) study in years 2015-2016, in which 864 preschool children participated (age 3-6 years old). Childreńs dietary intake was measured by a 3-day food record. We included only children that had complete data from all three days and the child was at day care on two of those days and one day was a weekend day (n = 568). To calculate the irregularity score, the absolute difference between the daily energy intake and 3-day mean intake for each three days was divided by the 3-day mean energy intake, multiplied by 100 and then averaged over the 3 days; this served as a measure of irregularity of energy intake, with a low score indicating a more regular energy intake and a higher more irregular energy intake. The parents reported highest parental educational level and household income on a questionnaire. The associations were tested by general linear models on SPSS.

Results

No association was found between parental educational level or household income with irregularity of children’s energy intake.

Conclusions

There was no association between parental socioeconomic status and children’s irregularity of energy intake. Other aspects of children’s chrono-nutrition should also be tested to be able to conclude that children’s chrono-nutrition is not influenced by parental socioeconomic status.

Key messages

• We found no association between parental socioeconomic status and irregularity in children’s energy intake.

• Chrono-nutrition among children is under-examined.

Parent-child nature visits and young Finnish childreńs nature connectedness

Background

It is well-known that frequent nature visits are associated with health benefits in children. Global climate crisis and environmental challenges emphasize the need for reconnecting children to nature, as well. Young children’s nature connectedness (NC) involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature. The study examines whether there is an association between the frequency of parent-child nature visits and young children’s NC.

Methods

The study uses WEB survey data from the Finnish Empowered by Nature project. Respondents, n = 1463, were parents of children aged 2 to 7 years old. NC was assessed by 11-items derived from the NC questionnaire of Sobko et al (2018). Multinomial logistic regression analysis was used and the lowest tertile of NC was used as reference group. Analysis were adjusted for child’s age and gender, and highest education of parent.

Results

Children with moderate (1-2 times a week in previous month) or high (3 times a week or more) frequency of parent-child nature visits were more likely to have strong than weak NC compared to children with low frequency (less than once a week) of adult-child nature visits. Odds ratios (OR) in adjusted models were: moderate frequency 1.67 (1.21- 2.32), and high frequency 2.31 (1.67-3.18). The odds of having medium NC compared to weak NC were more likely in moderate frequency compared to low frequency of parent-child nature visits in the adjusted model (OR 1.46; 1.07-2.00).

Conclusions

The results highlight the importance of parents visiting nature frequently with their children during early childhood. It promotes young children’s NC and may further contribute to raising environmentally responsible children.

Key messages

• More frequent parent-child visits promote young children’s nature connectedness which involves enjoyment of nature, sense of responsibility, empathy, and awareness of nature.

• A strong nature connectedness among children is highly relevant, as it may contribute to raise environmentally responsible children.

Implementation, home mediators and children’s sugary drink consumption - results from DAGIS study

Background and objectives

The effectiveness of a health behavior intervention can depend on the extent to which the intervention is implemented; higher degree of implementation (DOI) might associate with larger intervention effects. This study examined whether the parental DOI of an health behavior intervention had an effect on children's consumption of sugar-sweetened beverages (SSB) and was the effect mediated by home factors.

Methods

the DAGIS preschool intervention was conducted in 2017-2018 in Finland among 3-6-year-olds with valid data from 476 children. At baseline and follow-up parents reported 1) children's SSB consumption in a semi-quantified food frequency questionnaire, 2) availability of SSB at home, parental role modelling of drinking SSB, and norm (parental view on the suitable amount of SSB for children), and 3) DOI: a dichotomized sum variable on several aspects of parental program implementation. In the analyses, high and low DOI were compared to control group. Mediation analysis of the effect of DOI on the change in children's SSB consumption via change in availability, role modelling and norm was conducted with R statistical software.

Results

High DOI was associated with reduced consumption of SSB (B -27.71, 95% CI -49.05, -4.80). No mediated effects were found. All studied mediators impacted the change in SSB consumption, but the DOI had no effect on the change in mediators.

Conclusions

Intervention effect on the consumption of SSB was only found in the high DOI group, which supports the importance of assessing intervention implementation. Since the found effect was not mediated by the studied mediators, other possible mediators should be examined, as understanding intervention mediators is crucial in developing successful interventions.

Key messages

Preschool children’s temperament and its associations with energy intake

Background and objectives

Child's temperament dimensions have been linked with different weight outcomes as well as dietary factors such as consumption of fruit and vegetables, sugar-rich foods and drinks and an overall dietary quality. Links between temperament dimensions and energy intake, however, remain under-examined. This study expands the literature by investigating associations between child's temperament dimensions and energy intake.

Methods

Altogether 505 Finnish children aged 3-6 years provided data for the analyses. The data is a part of the DAGIS (Increased Health and Wellbeing in Preschools) study conducted in 2015-2016. Child's energy intake was measured with 3-day food records. To be included, children had to 1) have food record for two preschool days and one weekend day and 2) to have consumed both lunch and an afternoon snack in the preschool on the two preschool days. The very short form of Children's Behavior Questionnaire was used to measure child's temperament dimensions. Concurrent associations between three temperament dimensions (surgency, negative affectivity, and effortful control) and energy intake were examined using linear regression models adjusted for child's age, sex, mother's highest education, and moderate-to-vigorous physical activity.

Results

Surgency, temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake. Effortful control or negative affectivity were not associated with energy intake.

Conclusions

The findings imply that temperamental surgency may be one relevant determinant of energy intake among preschool children. The result is in line with previous studies linking child's surgency as well as its specific facets, such as impulsivity, with weight outcomes and food approach behaviors. Considering child's individual temperament dimensions when counselling families in eating issues could be beneficial.

Key messages

• Surgency, a temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake.

• When promoting children’s balanced eating, tailored support for parents acknowledging child’s temperament could be beneficial.

Computational hyperspectral light-sheet microscopy

We describe a computational light-sheet microscope designed for hyperspectral acquisition at high spectral resolution. The fluorescence light emitted from the full field-of-view is focused along the entrance slit of an imaging spectrometer using a cylindrical lens. To acquire the spatial dimension orthogonal to the slit of the spectrometer, we propose to illuminate the specimen with a sequence of structured light patterns and to solve the image reconstruction problem. Beam shaping is obtained simply using a digital micromirror device in conjunction with a traditional selective plane illumination microscopy setup. We demonstrate the feasibility of this method and report the first results in vivo in hydra specimens labeled using two fluorophores.

Analysis of the fecal microbiome in Kemp’s ridley sea turtles Lepidochelys kempii undergoing rehabilitation

The impact of the intestinal and fecal microbiome on animal health has received considerable attention in recent years and has direct implications for the veterinary and wildlife rehabilitation fields. To examine the effects of rehabilitation on the microbiome in Kemp’s ridley sea turtlesLepidochelys kempii, fecal samples from 30 incidentally captured juveniles were collected during rehabilitation. Samples were analyzed to determine alpha- (α) and beta- (β) diversity as well as the taxonomic abundance of the fecal microbiota during rehabilitation and in response to treatment with antibiotics. The fecal microbial communities of animals housed in rehabilitation for a ‘short-term’ stay (samples collected 0-9 d post-capture) were compared with ‘long-term’ (samples collected 10+ d post-capture) and ‘treated’ groups (samples collected from turtles that had received antibiotic medication). Results of this study indicate that the most dominant phylum in fecal samples wasBacteroidetes(relative abundance, 45.44 ± 5.92% [SD]), followed byFirmicutes(26.62 ± 1.58%),Fusobacteria(19.49 ± 9.07%), andProteobacteria(7.39 ± 1.84%). Similarly, at the family level,Fusobacteriaceae(28.36 ± 17.75%),Tannerellaceae(15.41 ± 10.50%),Bacteroidaceae(14.58 ± 8.48%), andRuminococcaceae(11.49 ± 3.47%) were the most abundant. Our results indicated that both antibiotic-treated and long-term rehabilitated turtles demonstrated a significant decrease in β-diversity when compared to short-term rehabilitated turtles. Our results likewise showed that the length of time turtles spent in rehabilitation was negatively correlated with α- and β-diversity. This study demonstrates the importance of a judicious use of antibiotics during the rehabilitation process and emphasizes the importance of limiting the length of hospital stays for sick and injured sea turtles as much as possible.

Determination of Glucosamine in Raw Materials and Dietary Supplements Containing Glucosamine Sulfate and/or Glucosamine Hydrochloride by High-Performance Liquid Chromatography with FMOC-Su Derivatization: Collaborative Study

A collaborative study was conducted for determination of glucosamine in raw materials and dietary supplements containing glucosamine sulfate and/or glucosamine hydrochloride by high-performance liquid chromatography (HPLC) with N-(9-fluorenyl-methoxycarbonyloxy) succinimide (FMOC-Su) derivatization. Thirteen blind materials, one pair of which were duplicates, were tested by 12 collaborating laboratories. The test samples consisted of various commercial products, including tablets, capsules, drink mix, and liquids as well as raw materials, blanks, and those for spike recovery analyses. The tests with blank products and products spiked with glucosamine showed good specificity of the method. The average recoveries at spike levels of 100 and 150% of the declared amount were 99.0% with a relative standard deviation (RSD) of 2.1%, and 101% with an RSD of 2.3%, respectively. The test results between laboratories on each commercial product were reproducible with RSD values of no more than 4.0%, and the results were repeatable in the same laboratory with an average RSD of 0.7%. HorRat values ranged from 0.5 to 1.7 on both tests of spike recovery and reproducibility between laboratories on commercial products. The average determination coefficient of the calibration curves from the laboratories was 0.9995 with an RSD of 0.03%. All of the 12 collaborating laboratories succeeded in the study and none of their reported test results were outliers, partly indicating the robustness of the method. It is recommended that the method be accepted by AOAC INTERNATIONAL as Official First Action.

Laboratory evaluation of secondary causes of bone loss in Veterans with spinal cord injury and disorders

An electronic health record (eHR) review of Veterans with a spinal cord injury and disorder (SCI/D) was conducted to understand the extent to which Veterans Affairs (VA) providers pursue workups for secondary causes of osteoporosis in this population. Laboratory tests for secondary causes were ordered in only one-third of Veterans, with secondary causes identified in two-thirds of those tested, most frequently, hypogonadism and hypovitaminosis D.

PURPOSE

To identify workups for secondary causes of osteoporosis in SCI/D and the extent to which subspecialty consultations are sought.

METHODS

A total of 3018 prescriptions for an osteoporosis medication (bisphosphonate, calcitonin, denosumab, raloxifene, teriparatide) among 2675 Veterans were identified in fiscal years 2005-2015 from VA administrative databases. Approximately 10% of these prescriptions were selected for eHR review.

RESULTS

eHR records of 187 Veterans with a SCI/D who had received pharmacological treatment for osteoporosis were reviewed. Workups for secondary causes of osteoporosis were performed in 31.5% of Veterans (n = 59) with approximately 64.4% of those tested (n = 38) having at least one abnormality. Hypogonadism (52.0% of those tested) and hypovitaminosis D (50.0% of those tested) were the most common secondary causes of osteoporosis identified in this population. Approximately 10% of primary care and SCI providers consulted subspecialists for further evaluation and treatment of osteoporosis. Endocrinologists more frequently performed a workup for secondary causes of osteoporosis compared to other provider specialties.

CONCLUSIONS

Screening for secondary causes of osteoporosis, particularly for hypogonadism and hypovitaminosis D, should be considered in patients with a SCI/D.

Children’s food intake in relation to preschool-level facilitators and barriers of healthy nutrition

Background

Childcare is an important setting for young children’s food consumption as, in Finland, most children eat three meals a day in childcare. Thus, it is important to recognize determinants of children’s dietary intake in childcare. The aim of this study was to examine food-related factors at preschool and manager-level and their association with children’s fruit, vegetable and fibre intake at preschool.

Methods

The study was a part of the cross-sectional DAGIS survey conducted in 2015-2016. It aimed to examine 3-6-year-old preschoolers’ energy balance-related behaviors in Finland. Preschool managers from 58 preschools filled in a questionnaire on food and nutrition related factors at preschool such as kitchen type, food policies, food education, the manager’s possibilities to impact fruit and vegetable supply and cooperation challenges with the catering service. Preschool personnel kept food record for the children (n = 585) on two preschool days. Multilevel linear and logistic regression analyses were conducted with age, gender and municipality as confounders, preschool-level factors as independent variables and children’s vegetable (g/day) and fruit (yes vs. no) consumption, and fibre intake (g/MJ) as outcome variables.

Results

Having many written food policies in the preschool was associated with higher intake of vegetables (p = 0.01) and fibre (p = 0.03) among the children. Having at least 2 out of 3 different cooperation challenges with the catering service was associated with higher intake of fibre (0.03) and lower odds of eating fruits (p = 0.01).

Conclusions

Written food policies and manager-reported challenges with the catering service were associated with children’s vegetable, fruit and fiber intake at preschool. Factors that are relatively distal from the meal situations may impact children’s food intake at preschool and should be taken into account when promoting healthy food intake at preschool, but more studies are needed.

Key messages

Written food policies and good cooperation between the preschool and catering services may be of benefit to children’s healthy food intake at preschool. The relation between preschool and manager-level factors and children’s food intake are very little studied, and thus more studies are needed before conclusions can be made.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

91 DISRUPTION OF TET1 DURING PORCINE EMBRYOGENESIS USING CRISPR/Cas9 SYSTEM

Ten-eleven translocation (TET) enzymes catalyse oxidation of 5-methylcytosine to 5-hydroxymethyl cytosine. This TET-mediated conversion of 5-methylcytosine to 5-hydroxymethyl cytosine is implicated in initiating the DNA demethylation process, observed post-fertilization. Three members (TET1–3) of the TET family are differentially expressed during embryo development and appear to have different roles. Previous studies in mice suggest that TET1 is a key regulator in maintaining pluripotency in embryonic stem cells by managing epigenetic marks such as DNA methylation. This would imply that TET1 should be a regulator of epigenetic marks during embryo development, although this has not been demonstrated. Previously, we have cloned porcine TET1 from blastocysts (GenBank accession number KC137683) and demonstrated that the level of TET1 (mRNA and protein) was high in blastocysts. The protein level was greater in the inner cell mass compared with the trophectoderm. In this study, we generated TET1 knockout porcine embryos using CRISPR/Cas9 system to study the role of TET1 in controlling epigenetic marks during porcine embryo development. First, 2 sgRNA, immediately downstream of the presumable translation initiation site, were designed and synthesised; location of the sgRNA were nucleotide position at 2 to 21 bp and 23 to 42 bp, respectively (KC137683). Then, sgRNA (10 ng μL−1 each) and Cas9 mRNA (20 ng μL−1) were injected into the cytoplasm of IVF zygotes, and Day 7 blastocysts were genotyped. All embryos carried mutations on both alleles of TET1 (10/10), one homozygous and 9 biallelic mutations. However, immunocytochemistry analysis of other CRISPR/Cas9 injected embryos revealed that TET1 was not removed (10/10), indicating that the sgRNA may have not introduced a premature stop codon 3′ to the presumable translation initiation site. Therefore, 2 new sgRNA were designed to generate a premature stop codon at the 5′ side of a key functional domain, the 2-oxoglutarate-Fe(II)-dependent oxygenase domain (4690 to 5160 bp); the locations of the 2 sgRNA were 4450 to 4469 bp and 4501 to 4520 bp, respectively. Similarly, all of the embryos carried mutations in TET1 (7/7), 2 homozygous and 5 biallelic mutations. In addition, TET1 proteins were not detected in 11 of 16 blastocysts, confirmed by immunocytochemistry. In this study, we successfully generated embryos lacking TET1 by introducing designed CRISPR/Cas9 system during embryogenesis. Presence of TET1 from the first injection experiment suggests that the presumable translation initiation site is not accurate. Discrepancy between genotyping and immunocytochemistry results from the second injection experiment indicates that embryos possessing TET1 protein probably have mutations in triplets, thus no premature stop codon was synthesised. Further studies will focus on identifying the role of TET1 in maintaining pluripotency and epigenetic modification during pre-implantation stage using these embryos.

Biallelic modification of IL2RG leads to severe combined immunodeficiency in pigs

BACKGROUND

Pigs with SCID can be a useful model in regenerative medicine, xenotransplantation, and cancer cell transplantation studies. Utilizing genome editing technologies such as CRISPR/Cas9 system allows us to generate genetically engineered pigs at a higher efficiency. In this study, we report generation and phenotypic characterization of IL2RG knockout female pigs produced through combination of CRISPR/Cas9 system and SCNT. As expected, pigs lacking IL2RG presented SCID phenotype.

METHODS

First, specific CRISPR/Cas9 systems targeting IL2RG were introduced into developing pig embryos then the embryos were transferred into surrogates. A total of six fetuses were obtained from the embryo transfer and fetal fibroblast cell lines were established. Then IL2RG knockout female cells carrying biallelic genetic modification were used as donor cells for SCNT, followed by embryo transfer.

RESULTS

Three live cloned female piglets carrying biallelic mutations in IL2RG were produced. All cloned piglets completely lacked thymus and they had a significantly reduced level of mature T, B and NK cells in their blood and spleen.

CONCLUSIONS

Here, we generated IL2RG knockout female pigs showing phenotypic characterization of SCID. This IL2RG knockout female pigs will be a promising model for biomedical and translational research.

Childcare use and overweight in Finland: cross-sectional and retrospective associations among 3- and 5-year-old children

BACKGROUND

Different types of non-parental childcare have been found to associate with childhood overweight in several, but not all studies. Studies on the matter are mainly North American.

OBJECTIVES

The objective of our study was to examine associations between childcare use and overweight in Finland.

METHODS

The cross-sectional and partly retrospective data consists of 1683 3- and 5-year-old children participating in the Child Health Monitoring Development project (LATE-project) conducted in 2007-2009 in Finland. Children were measured at health check-ups and information on child's age when entering childcare, the number of childcare places the child has had, current type of childcare (parental, informal, [group] family childcare, childcare centre) and the current amount of childcare (hours) were gathered. Parents' body mass indices, family educational level, family structure, maternal smoking during pregnancy and child's birth weight were treated as covariates.

RESULTS

Beginning childcare before age 1 (adjusted model: odds ratio [OR] 2.53, 95% confidence interval [CI] 1.41-4.52) and, for girls only, number of childcare places (adjusted model: OR 1.33, 95% CI 1.11-1.60), were associated with an increased risk of overweight. The current type of childcare or the time currently spent in childcare was not associated with overweight.

CONCLUSION

Beginning childcare before age 1, which is quite rare in Finland, and having attended several childcare places were associated with overweight even when adjusting for family socioeconomic status and other family background variables. The significance of these findings needs to be further studied.