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STRUCUTRED ABSTRACTO_ST_ABSObjectivesC_ST_ABSEnsuring a high COVID-19 vaccine uptake among U.S. child care providers is crucial to mitigating the public health implications of child-to-staff and staff-to-child transmission of SARS-CoV-2; however, the vaccination rate among this group is unknown. MethodsTo characterize the vaccine uptake among U.S. child care providers, we conducted a cross-sectional survey of the child care workforce. Providers were identified through various national databases and state registries. A link to the survey was sent via email between May 26 and June 23, 2021. Out of 44,771 potential respondents, 21,663 responded (48.4%). ResultsOverall COVID-19 vaccine uptake among U.S. child care providers (78.1%, 95% CI [77.3% to 78.9%]) was higher than that of the U.S. adult population (65%). Vaccination rates varied from 53.5% to 89.4% between states. Vaccine uptake differed significantly (p < .01) based on respondent age (70.0% for ages 25-34, 91.5% for ages 75-84), race (70.0% for Black or African Americans, 92.5% for Asian-Americans), annual household income (70.7% for <$35,000, 85.0% for>$75,000), and childcare setting (72.9% for home-based, 79.7% for center-based). ConclusionsCOVID-19 vaccine uptake among U.S. child care providers was higher than that of the general U.S. adult population. Those who were younger, lower income, Black or African American, resided in states either in the Mountain West or the South, and/or worked in home-based childcare programs reported the lowest rates of vaccination; state public health leaders and lawmakers should prioritize these subgroups for placement on the policy agenda to realize the largest gains in vaccine uptake among providers. Tables of Contents SummaryThis article describes the results of a national survey of childcare providers to determine the overall COVID-19 vaccine uptake and the gaps in vaccine coverage. Whats Known on This SubjectEnsuring a high COVID-19 vaccine uptake among U.S. child care providers is crucial to mitigating the public health implications of child-to-staff and staff-to-child transmission of SARS-CoV-2; however, the vaccination rate among this group is unknown. What This Study AddsWhile the vaccine uptake among U.S. child care providers was higher than that of U.S. adults, certain subgroups continue to warrant focused attention for outreach and/or placement on the policy agenda.

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ImportanceType 2 diabetes (T2DM) and obesity are significant risk factors for mortality in Covid19. Metformin has sex specific immunomodulatory effects which may elucidate treatment mechanisms in COVID-19. Objective: We sought to identify whether metformin reduced mortality from Covid19 and if sex specific interactions exist. DesignRetrospective review of de-identified claims from UnitedHealth Groups Clinical Discovery Database. Unadjusted and multivariate models were conducted to assess risk of mortality based on metformin and tumor necrosis factor alpha (TNF) inhibitors as home medications in individuals with T2DM and obesity, controlling for comorbidities, medications, demographics, and state. Heterogeneity of effect was assessed by sex. SettingThe database includes all 50 states in the United States. Participants: Persons with at least 6 months of continuous coverage from UnitedHealth Group in 2019 who were hospitalized with Covid-19. Persons in the metformin group had > 90 days of metformin claims in the 12 months before hospitalization. Results6,256 persons were included; 52.8% female; mean age 75 years. Metformin was associated with decreased mortality in women by logistic regression, OR 0.792 (0.640, 0.979); mixed effects OR 0.780 (0.631, 0.965); Cox proportional-hazards: HR 0.785 (0.650, 0.951); and propensity matching, OR of 0.759 (0.601, 0.960). There was no significant reduction in mortality among men. TNF inhibitors were associated with decreased mortality, by propensity matching in a limited model, OR 0.19 (0.0378, 0.983). ConclusionsMetformin was significantly associated with reduced mortality in women with obesity or T2DM in observational analyses of claims data from individuals hospitalized with Covid-19. This sex-specific finding is consistent with metformins reduction of TNF in females over males, and suggests that metformin conveys protection in Covid-19 through TNF effects. Prospective studies are needed to understand mechanism and causality. Key PointsO_ST_ABSQuestionC_ST_ABSMetformin has many anti-inflammatory effects, including sex-specific effects on TNF. Is metformin protective from the Sars-CoV-2 virus, and does the effect differ by sex? FindingsMetformin was associated with reduced mortality in women who were hospitalized with Covid-19, but not in men who were hospitalized with Covid-19. MeaningThe sex-dependent survival by metformin use points towards TNF reduction as a key mechanism for protection from Covid-19.

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A solid-phase synthesis protocol was used to prepare fifteen new linear tetra-, and penta-esters structurally related to an active lead compound. The structures were assembled from three types of hydroxyl protected building blocks: monoalkyl esters of hydroxyglutaric acid, omega-hydroxyacids, and alpha-hydroxymethylalkanoic acids. The standard methodology gave acceptable quantities of material free of small molecule impurities. Mass spectrometric analysis revealed the presence of deletions due to incomplete coupling, as well as additions and macrolactones due to partial acidic rearrangement on release from the solid-support. The amount of these impurities could be estimated from the (1)H NMR spectra, and their implications for subsequent activity analysis are discussed.

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The ion transport activity of eighteen linear oligoesters was assessed using a quantitative fluorescence assay to monitor the collapse of a pH gradient across a vesicle bilayer membrane. Significant activity was associated with compounds that have extended lengths comparable to the thickness of the bilayer membrane, and with the most hydrophilic members of the compounds surveyed. Substantial differences in activity between constitutional isomers were also observed. The aggregation of active compounds in aqueous solution was detected by a pyrene fluorescence probe, and subsequently detected as a rate-limiting step in a sequential vesicle experiment.

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To determine the prevalence and significant correlates of exclusive breast-feeding among nursing mothers, we conducted a survey among nursing mothers attending the Wellness Baby Clinic in Tobago from July 1 to December 1, 1998. A random sample of 151 mothers had face-to-face interviews with a standardized pretested questionnaire. Our results suggest that 48.3% and 20.8% of infants were exclusively breast-fed at two and four months respectively. Univariate logistic regression analyses showed that exclusive breast-feeding at two months was significantly positively associated with years of schooling completed by the mother, frequency of prenatal visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding, and occupation of the child's father. Exclusive breast-feeding at four months was significantly positively associated with mother's age, years of schooling completed by the mother, frequency of prenatal visits, mother's knowledge of the recommended duration of breast-feeding, years of schooling completed by the child's father and occupation of the child's father. In multivariate logistic analyses, adjusting simultaneously for all relevant explanatory variables, exclusive breast-feeding at two months was significantly positively associated with frequency of prenatal clinic visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding and occupation of the child's father. In addition, exclusive breast-feeding at four months was significantly positively associated with frequency of prenatal clinic visits, length of hospital stay, mother's knowledge of recommended duration of breast-feeding, years of schooling completed by the child's father, family structure and inversely associated with mother's age. In this sample, parental socio-demographic characteristics and health system factors were associated with subsequent infant feeding practices.

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To determine the prevalence and significant correlates of exclusive breast-feeding among nursing mothers, we conducted a survey among nursing mothers attending the Wellness Baby Clinic in Tobago from July 1 to December 1, 1998. A random sample of 151 mothers had face-to-face interviews with a standardized pretested questionnaire. Our results suggest that 48.3 and 20.8 of infants were exclusively breast-fed at two and four months respectively. Univariate logistic regression analyses showed that exclusive breast-feeding at two months was significantly positively associated with years of schooling completed by the mother, frequency of prenatal visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding, and occupation of the child's father. Exclusive breast-feeding at four months was significantly positively associated with mother's age, years of schooling completed by the mother, frequency of prenatal visits, mother's knowledge of the recommended duration of breast-feeding, years of schooling completed by the child's father and occupation of the child's father. In multivariate logistic analyses, adjusting simultaneously for all relevant explanatory variables, exclusive breast-feeding at two months was significantly positively associated with frequency of prenatal clinic visits, mode of breast-feeding, mother's knowledge of the recommended duration of breast-feeding and occupation of the child's father. In addition, exclusive breast-feeding at four months was significantly positively associated with frequency of prenatal clinic visits, length of hospital stay, mother's knowledge of recommended duration of breast-feeding, years of schooling completed by the child's father, family structure and inversely associated with mother's age. In this sample, parental socio-demographic characteristics and health system factors were associated with subsequent infant feeding practices.

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