ABSTRACT
Microplastics (MP) have repeatedly been found in commercially cultured species of bivalves. There are concerns regarding the amount of MP released into the environment by aquaculture activities, and questions regarding possible higher MP loads in farm-grown shellfish compared to levels in shellfish collected from recreational beds. To explore this concept, seawater, aquaculture gear, and eastern oysters (Crassostrea virginica) were sampled from an aquaculture site in Niantic Bay, CT, USA, and a 2-week transplantation experiment was performed in which oysters were transplanted between the aquaculture site and a plastic-free cage off the dock at the University of Connecticut-Avery Point campus. The digestive gland-stomach complex (gut) was dissected from the oysters and MP were extracted from the adjacent seawater and oyster gut samples using previously validated extraction methods. Extensive quality assurance and control measures were taken to reduce MP contamination. Particles in all samples were isolated, imaged under a stereomicroscope, and characterized (size, shape, polymer) using ImageJ software and micro-Fourier transform infrared spectroscopy. Water samples contained 0-0.3 MP/L and oyster gut samples contained 0-1.3 MP/g wet weight indicating very low concentrations of MP at the farm (0-2 MP/individual) or away from the farm (0-3 MP/individual). Aquaculture gear in this area is not contributing to MP ingestion in farmed oysters or elevated MP levels in the surrounding water.
Subject(s)
Aquaculture , Crassostrea , Environmental Monitoring , Microplastics , Water Pollutants, Chemical , Animals , Water Pollutants, Chemical/analysis , Microplastics/analysis , Shellfish/analysis , Seawater/chemistry , ConnecticutABSTRACT
OBJECTIVES: The objective of this study was to estimate prevalence of hepatitis C virus (HCV) exposure and infection among Indigenous and tribal populations globally. STUDY DESIGN: Systematic review and meta-analysis. METHODS: We systematically searched bibliographic databases and grey literature (1/01/2000-16/06/2022). Prevalence estimates were synthesised overall, by World Health Organization region and HCV-risk group. For studies with comparator populations, prevalence ratios were estimated and pooled. RESULTS: Ninety-two studies were included. Globally, among general Indigenous and tribal populations, the median prevalence of HCV antibody (HCV Ab) was 1.3% (interquartile range [IQR]: 0.3-3.8%, I2 = 98.5%) and HCV RNA was 0.4% (IQR: 0-1.3%, I2 = 96.1%). The Western Pacific Region had the highest prevalence (HCV Ab: median: 3.0% [IQR: 0.4-11.9%], HCV RNA: median 5.6% [IQR: 2.0-8.8%]). Prevalence was highest in people who injected drugs (HCV Ab: median: 59.5%, IQR: 51.5-67.6%, I2 = 96.6%; and HCV RNA: median: 29.4%, IQR: 21.8-35.2%, I2 = 97.2%). There was no association between HCV Ab prevalence and Indigenous/tribal status for general populations (prevalence ratio = 0.91; 95% CI: 0.56, 1.49) or key risk groups. CONCLUSIONS: Indigenous and tribal peoples from the Western Pacific Region and recognised at-risk sub-populations had higher HCV prevalence. HCV prevalence showed no association with Indigenous/tribal status. However, this review was limited by heterogeneity and poor quality of constituent studies, varying definitions of Indigenous/tribal status, regional data gaps, and limited studies on chronic infection (HCV RNA). Comprehensive quality evidence on HCV epidemiology in Indigenous and tribal peoples is needed to tailor preventive and treatment interventions so these populations are not left behind in elimination efforts.
Subject(s)
Hepatitis C , Indigenous Peoples , Humans , Hepatitis C/epidemiology , Hepatitis C/ethnology , Prevalence , Indigenous Peoples/statistics & numerical data , Hepacivirus/isolation & purification , Global Health/statistics & numerical data , Population Groups/statistics & numerical data , Risk FactorsABSTRACT
A system of partial differential equations is developed to study the spreading of tau pathology in the brain for Alzheimer's and other neurodegenerative diseases. Two cases are considered with one assuming intracellular diffusion through synaptic activities or the nanotubes that connect the adjacent cells. The other, in addition to intracellular spreading, takes into account of the secretion of the tau species which are able to diffuse, move with the interstitial fluid flow and subsequently taken up by the surrounding cells providing an alternative pathway for disease spreading. Cross membrane transport of the tau species are considered enabling us to examine the role of extracellular clearance of tau protein on the disease status. Bifurcation analysis is carried out for the steady states of the spatially homogeneous system yielding the results that fast cross-membrane transport combined with effective extracellular clearance is key to maintain the brain's healthy status. Numerical simulations of the first case exhibit solutions of travelling wave form describing the gradual outward spreading of the pathology; whereas the second case shows faster spreading with the buildup of neurofibrillary tangles quickly elevated throughout. Our investigation thus indicates that the gradual progression of the intracellular spreading case is more consistent with the clinical observations of the development of Alzheimer's disease.
Subject(s)
Alzheimer Disease , Brain , Computer Simulation , Mathematical Concepts , Neurodegenerative Diseases , tau Proteins , tau Proteins/metabolism , Humans , Alzheimer Disease/metabolism , Alzheimer Disease/pathology , Neurodegenerative Diseases/metabolism , Neurodegenerative Diseases/pathology , Brain/metabolism , Brain/pathology , Models, Neurological , Neurofibrillary Tangles/metabolism , Neurofibrillary Tangles/pathology , Models, Biological , Disease Progression , Tauopathies/metabolism , Tauopathies/pathologyABSTRACT
Opioid use disorder (OUD) is an ongoing public health concern in the United States, and relatively little work has addressed how genetic background contributes to OUD. Understanding the genetic contributions to oxycodone-induced analgesia could provide insight into the early stages of OUD development. Here, we present findings from a behavioral phenotyping protocol using several inbred strains from the Hybrid Rat Diversity Panel. Our behavioral protocol included a modified "up-down" von Frey procedure to measure inherent strain differences in the sensitivity to a mechanical stimulus on the hindpaw. We also performed the tail immersion assay, which measures the latency to display tail withdrawal in response to a hot water bath. Initial withdrawal thresholds were taken in drug-naïve animals to record baseline thermal sensitivity across the strains. Oxycodone-induced analgesia was measured after administration of oxycodone over the course of 2 h. Both mechanical and thermal sensitivity are shaped by genetic factors and display moderate heritability (h2 = 0.23-0.40). All strains displayed oxycodone-induced analgesia that peaked at 15-30 min and returned to baseline by 2 h. There were significant differences between the strains in the magnitude and duration of their analgesic response to oxycodone, although the heritability estimates were quite modest (h2 = 0.10-0.15). These data demonstrate that genetic background confers differences in mechanical sensitivity, thermal sensitivity, and oxycodone-induced analgesia.
Subject(s)
Analgesia , Opioid-Related Disorders , Rats , Animals , Oxycodone/pharmacology , Analgesics, Opioid/pharmacologyABSTRACT
The question of whether physical pain and vicarious pain have some shared neural substrates is unresolved. Recent research has argued that physical and vicarious pain are represented by dissociable multivariate brain patterns by creating biomarkers for physical pain (Neurologic Pain Signature, NPS) and vicarious pain (Vicarious Pain Signature, VPS), respectively. In the current research, the NPS and two versions of the VPS were applied to three fMRI datasets (one new, two published) relating to vicarious pain which focused on between-subject differences in vicarious pain (Datasets 1 and 3) and within-subject manipulations of perspective taking (Dataset 2). Results show that (i) NPS can distinguish brain responses to images of pain vs no-pain and to a greater extent in vicarious pain responders who report experiencing pain when observing pain and (ii) neither version of the VPS mapped on to individual differences in vicarious pain and the two versions differed in their success in predicting vicarious pain overall. This study suggests that the NPS (created to detect physical pain) is, under some circumstances, sensitive to vicarious pain and there is significant variability in VPS measures (created to detect vicarious pain) to act as generalizable biomarkers of vicarious pain.
Subject(s)
Empathy , Pain Perception , Humans , Pain Perception/physiology , Pain , Brain/diagnostic imaging , Brain/physiology , BiomarkersABSTRACT
AIM: This study aims to establish whether digital surveillance methods for notifiable diseases in Australia collect and report data in relation to marginalised populations. METHODS: The literature was systematically reviewed to identify primary research studies published between January 2005 and July 2023. Studies were included if they described an Australian digital surveillance system for notifiable conditions. The results were synthesised with a focus on evaluating the collection and reporting of data in relation to marginalised populations. RESULTS: A total of 13 articles reporting on seven surveillance systems were identified. Influenza and adverse events following immunisation were the two most common notifiable conditions monitored. A total of six surveillance systems encompassing 16 articles reported information on sub-populations. Of these, three surveillance systems (nine articles) included data on marginalised populations. CONCLUSION: The data collected or reported in relation to sub-groups that characterise diversity in terms of health care needs, access, and marginalised populations are minimal. It is recommended that a set of equity and reporting principles is established for the future creation and use of any digital surveillance system.
Subject(s)
Population Surveillance , Humans , Australia/epidemiology , Disease Notification/methods , Population Surveillance/methodsABSTRACT
OBJECTIVES: Indigenous children in Australia experience high burden of persistent otitis media (OM) from very early age. The aim was to identify distinct trajectories of OM in children up to age 10-12 years and examine the association with socio-economic determinants. STUDY DESIGN: A multistage clustered national panel survey. METHODS: The study analysed the birth cohort of the Longitudinal Study of Indigenous Children from 2008 to 2018, comprising 11 study waves. Group-based trajectory modelling was used to identify different trajectories of OM outcome. Multinomial logistic regression was applied to examine the relationship between trajectories and individual, household and community-level socio-economic determinants. RESULTS: This analysis included 894 children with at least three responses on OM over the 11 waves, and the baseline mean age was 15.8 months. Three different trajectories of OM were identified: non-severe OM prone, early/persistent severe OM and late-onset severe OM. Overall, 11.4% of the children had early/persistent severe OM from birth to 7.5 to nine years, while late-onset severe OM consisted of 9.8% of the children who had first OM from age 3.5 to five years. Children in communities with middle and the highest socio-economic outcomes have lower relative risk of early/persistent severe OM (adjusted relative risk ratio = 0.39, 95% confidence interval = 0.22-0.70 and adjusted relative risk ratio = 0.22, 95% confidence interval = 0.09-0.52, respectively) compared to children in communities with lowest socio-economic outcomes. CONCLUSION: Efforts to close the gap in the quality of life of Indigenous children must prioritise strategies that prevent severe ear disease (runny ears and perforation), including improved healthcare access, reduced household crowding, and better education, and more employment opportunities.
Subject(s)
Otitis Media , Quality of Life , Child , Humans , Infant , Child, Preschool , Longitudinal Studies , Crowding , Family Characteristics , Otitis Media/epidemiology , Otitis Media/complications , Australia/epidemiologyABSTRACT
The blue mussel (Mytilus edulis) is a suspension feeder which has been used in gut-microbiome surveys. Although raw 16S sequence data are often publicly available, unifying secondary analyses are lacking. The present work analysed raw data from seven projects conducted by one group over 7 years. Although each project had different motivations, experimental designs and conclusions, all selected samples were from the guts of M. edulis collected from a single location in Long Island Sound. The goal of this analysis was to determine which independent factors (e.g., collection date, depuration status) were responsible for governing composition and diversity in the gut microbiomes. Results indicated that whether mussels had undergone depuration, defined here as voidance of faeces in a controlled, no-food period, was the primary factor that governed gut microbiome composition. Gut microbiomes from non-depurated mussels were mixtures of resident and transient communities and were influenced by temporal factors. Resident communities from depurated mussels were influenced by the final food source and length of time host mussels were held under laboratory conditions. These findings reinforce the paradigm that gut microbiota are divided into resident and transient components and suggest that depuration status should be taken into consideration when designing and interpreting future experiments.
Subject(s)
Gastrointestinal Microbiome , Mytilus edulis , Mytilus , Animals , SeafoodABSTRACT
Patent microvascular anastomoses are essential for successful free tissue transfer. Early accurate detection of microvascular compromise is required for flap salvage. Adjunctive monitoring techniques, in addition to clinical examination, are increasingly used to detect flap compromise. This systematic review synthesized and appraised the literature to determine the efficacy of different postoperative monitoring technologies. Rates of flap takeback, salvage, failure, and mean time to detection of microvascular compromise were extracted, synthesized, and reviewed. Twenty-two studies were included, comprising 6370 flaps. One thousand three hundred and ninety-five flaps were monitored with Cook Swartz Doppler (21.83%), 1417 flaps with tissue oximetry (22.24%), 291 with laser Doppler (4.56%), 175 with duplex echography (2.74%), 210 with indocyanine green (ICG) fluorescence (3.30%), 196 with Synovis flow coupler (3.07%), and 81 (1.27%) with light spectroscopy. The overall true positive rate for microvascular compromise in taken back flaps was 70.18%. Cook Swartz Doppler (n = 1391) had a true positive rate of 80.17% and 83.63% salvage rate and was associated with an overall 2.60% rate of flap failure. Tissue oximetry (n = 1417) had a true positive rate of 74.76% and a salvage rate of 88.62%. Laser Doppler, duplex echography, light spectroscopy, and Synovis flow coupler demonstrated true positive rates between 69.4% and 100% with salvage rates between 64% and 100%. Cook Swartz Doppler and tissue oximetry are associated with prompt identification of microvascular compromise and return to theatre. Alternative modalities, including near-infrared spectroscopy, laser Doppler, and duplex echography, show promise. Further well-designed randomised controlled trials (RCTs) appraising head-to-head efficacy are required to comparatively assess adjunctive technologies.
Subject(s)
Free Tissue Flaps , Humans , Free Tissue Flaps/blood supply , Monitoring, Physiologic/methods , Ultrasonography, Doppler/methods , Physical Examination , Ultrasonography, Doppler, Duplex , Postoperative Complications , Retrospective StudiesABSTRACT
Ingestion of microplastics (MP) by suspension-feeding bivalves has been well-documented. However, it is unclear whether exposure to MP could damage the stomach and digestive gland (gut) of these animals, causing ramifications for organism and ecosystem health. Here, we show no apparent effects of nylon microfiber (MF) ingestion on the gut microbiome or digestive tissues of the blue mussel, Mytilus edulis. We exposed mussels to two low concentrations (50 and 100 particles/L) of either nylon MF or Spartina spp. particles (dried, ground marsh grass), ca. 250-500 µm in length, or a no particle control laboratory treatment for 21 days. Results showed that nylon MF, when aged in coarsely filtered seawater, developed a different microbial community than Spartina spp. particles and seawater, however, even after exposure to this different community, mussel gut microbial communities resisted disturbance from nylon MF. The microbial communities of experimental mussels clustered together in ordination and were similar in taxonomic composition and measures of alpha diversity. Additionally, there was no evidence of damage to gut tissues after ingestion of nylon MF or Spartina spp. Post-ingestive particle processing likely mediated a short gut retention time of these relatively large particles, contributing to the negligible treatment effects.
Subject(s)
Gastrointestinal Microbiome , Mytilus edulis , Mytilus , Water Pollutants, Chemical , Animals , Nylons , Plastics , Ecosystem , Water Pollutants, Chemical/analysisABSTRACT
Microplastics (MP, <5 mm) are found in coastal waters across various environmental compartments (biota, water, marine snow, sediment). The eastern oyster (Crassostrea virginica) is a commercially important species that ingests MP; however, oysters are discriminant suspension feeders that do not consume all particles to which they are exposed. This study explored the relationship between MP in oysters on a recreational oyster bed and the surrounding environmental compartments in Long Island Sound (LIS; USA). The quantity and types of MP in oysters, water, marine snow, and sediment samples were determined. Precautions were taken to minimize and monitor MP contamination in the field and laboratory to improve the quality of data collected. Microplastics were isolated from samples via chemical digestion, and any suspected particles were identified using micro-Fourier transform infrared spectroscopy. A total of 86 MP were identified out of 885 suspected particles across environmental media. The highest MP count in an individual oyster was nine, indicating low concentrations of MP in oysters and the surrounding environment. Few polymers, except polyethylene terephthalate, were shared between oysters and the surrounding environmental compartments. Sediments contained the highest number of MP across all environmental compartments (42 total). These data aid in determining the types of MP (polymer composition, shape, size) to which oysters are exposed and identified those ingested. The low numbers of MP recorded, coupled with the lack of alignment of polymers between oysters and their surrounding environment, demonstrates further that oysters are a poor bioindicator species for MP pollution.
Subject(s)
Crassostrea , Water Pollutants, Chemical , Animals , Microplastics , Plastics , Environmental Monitoring , Water Pollutants, Chemical/analysis , WaterABSTRACT
BACKGROUND: Echocardiographic indices of the inferior vena cava have been associated with elevated right atrial pressures in humans. HYPOTHESIS/OBJECTIVES: Describe caudal vena caval (CVC) sonographic dimensions in healthy cats compared to cats with cardiogenic cavitary effusion (CCE), cardiogenic pulmonary edema (CPE), or non-cardiac causes of cavitary effusion (NCE). ANIMALS: 30 healthy control cats and 52 client-owned cats with CCE, CPE, or NCE examined at two university hospitals. METHODS: Sagittal 2-dimensional (2D) and M-mode CVC dimensions were acquired from the subxiphoid view. Caudal vena cava collapsibility index (CVC-CI) was calculated. Variables were compared between study groups using Kruskal-Wallis and Dunn's Bonferroni testing. Receiver operating characteristic curves were used to assess sensitivity and specificity for diagnostic categories. RESULTS: Healthy cats had sagittal 2D and M-mode (median, interquartile range) CVC maximal dimensions of 2.4 mm (1.3-4.0) and 3.4 mm (1.5-4.9) and CVC-CI of 52% (45.2-61.8) and 55% (47.8-61.3), respectively. The CVC maximal dimensions in healthy controls were smaller than in cats with cavitary effusions or pulmonary edema (all P<0.05). CVC-CI was different between CCE and NCE (P<0.0001) with cutoffs of CVC-CI ≤38% (2D) or ≤29% (M-mode) being 90.5% and 85.7% sensitive, and 94.4% and 100% specific for diagnosis of CCE, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Caudal vena cava measurements are larger in cats with cavitary effusions and cats with CPE than healthy cats. In cats with cavitary effusion, decreased CVC-CI, ≤38% (2D) or ≤29% (M-mode), was helpful in distinguishing between cardiogenic and noncardiogenic etiology.
Subject(s)
Cat Diseases , Heart Failure , Pulmonary Edema , Humans , Cats , Animals , Pulmonary Edema/veterinary , Vena Cava, Inferior/diagnostic imaging , Echocardiography/veterinary , Heart Failure/diagnostic imaging , Heart Failure/veterinary , Heart Failure/complications , Ultrasonography/veterinary , Cat Diseases/diagnostic imagingABSTRACT
Misophonia is an unusually strong aversion to everyday sounds such as chewing, crunching, or breathing. Previous studies have suggested that rates of autism might be elevated in misophonia, and here we examine this claim in detail. We present a comprehensive review of the relevant literature, and two empirical studies examining children and adults with misophonia. We tested 142 children and 379 adults for traits associated with autism (i.e., attention-to-detail, attention-switching, social processing, communication, imagination, emotion regulation, and sensory sensitivity across multiple domains). Our data show that autistic traits are indeed elevated in misophonics compared to controls. We discuss our findings in relation to models of the interface between autism, sensory sensitivities, and the specific features of misophonia.
Subject(s)
Autism Spectrum Disorder , Autistic Disorder , Emotional Regulation , Humans , Adult , Child , Hearing DisordersABSTRACT
Sodium fluoroacetate (FA) is a metabolic poison that systemically inhibits the tricarboxylic acid (TCA) cycle, causing energy deficiency and ultimately multi-organ failure. It poses a significant threat to society because of its high toxicity, potential use as a chemical weapon and lack of effective antidotal therapy. In this study, we investigated cell-permeable succinate prodrugs as potential treatment for acute FA intoxication. We hypothesized that succinate prodrugs would bypass FA-induced mitochondrial dysfunction, provide metabolic support, and prevent metabolic crisis during acute FA intoxication. To test this hypothesis, rats were exposed to FA (0.75 mg/kg) and treated with the succinate prodrug candidate NV354. Treatment efficacy was evaluated based on cardiac and cerebral mitochondrial respiration, mitochondrial content, metabolic profiles and tissue pathology. In the heart, FA increased concentrations of the TCA metabolite citrate (+ 4.2-fold, p < 0.01) and lowered ATP levels (- 1.9-fold, p < 0.001), confirming the inhibition of the TCA cycle by FA. High-resolution respirometry of cardiac mitochondria further revealed an impairment of mitochondrial complex V (CV)-linked metabolism, as evident by a reduced phosphorylation system control ratio (- 41%, p < 0.05). The inhibition of CV-linked metabolism is a novel mechanism of FA cardiac toxicity, which has implications for drug development and which NV354 was unable to counteract at the given dose. In the brain, FA induced the accumulation of ß-hydroxybutyrate (+ 1.4-fold, p < 0.05) and the reduction of mitochondrial complex I (CI)-linked oxidative phosphorylation (OXPHOSCI) (- 20%, p < 0.01), the latter of which was successfully alleviated by NV354. This promising effect of NV354 warrants further investigations to determine its potential neuroprotective effects.
Subject(s)
Prodrugs , Rats , Animals , Prodrugs/pharmacology , Prodrugs/metabolism , Succinic Acid/metabolism , Mitochondria/metabolism , Oxidative Phosphorylation , Electron Transport Complex I/metabolism , Fluoroacetates/pharmacology , Fluoroacetates/metabolismABSTRACT
Pesticides account for hundreds of millions of cases of acute poisoning worldwide each year, with organophosphates (OPs) being responsible for the majority of all pesticide-related deaths. OPs inhibit the enzyme acetylcholinesterase (AChE), which leads to impairment of the central- and peripheral nervous system. Current standard of care (SOC) alleviates acute neurologic-, cardiovascular- and respiratory symptoms and reduces short term mortality. However, survivors often demonstrate significant neurologic sequelae. This highlights the critical need for further development of adjunctive therapies with novel targets. While the inhibition of AChE is thought to be the main mechanism of injury, mitochondrial dysfunction and resulting metabolic crisis may contribute to the overall toxicity of these agents. We hypothesized that the mitochondrially targeted succinate prodrug NV354 would support mitochondrial function and reduce brain injury during acute intoxication with the OP diisopropylfluorophosphate (DFP). To this end, we developed a rat model of acute DFP intoxication and evaluated the efficacy of NV354 as adjunctive therapy to SOC treatment with atropine and pralidoxime. We demonstrate that NV354, in combination with atropine and pralidoxime therapy, significantly improved cerebral mitochondrial complex IV-linked respiration and reduced signs of brain injury in a rodent model of acute DFP exposure.
Subject(s)
Brain Injuries , Organophosphate Poisoning , Prodrugs , Animals , Rats , Organophosphate Poisoning/drug therapy , Atropine/pharmacology , Atropine/therapeutic use , Prodrugs/pharmacology , Isoflurophate/toxicity , Succinic Acid , Acetylcholinesterase/metabolism , Rodentia/metabolism , Succinates , Mitochondria/metabolism , Brain Injuries/drug therapyABSTRACT
Suspension feeding bivalve molluscs interact with different types of microplastics (MP) suspended in the water column. Most bivalves are selective suspension feeders and, thus, do not consume all particles to which they are exposed. Selection depends upon the physicochemical properties and size of the particle. Recent work has provided evidence that blue mussels, Mytilus edulis, and eastern oysters, Crassostrea virginica, ingest and egest microspheres (polystyrene) and microfibers (nylon) differently, but whether other factors, such as polymer type and shape, mediate selection have not been explored. To investigate these factors, mussels and oysters were offered similar sized nylon (Ny) and polyester (PES) microfibers or polyethylene (PE) and polystyrene (PS) microspheres, or different sized PES microfibers during a 2 h exposure. Feces and pseudofeces were collected separately and analyzed for MPs, and the data were used to develop a linear regression model for selection. Results demonstrated clear species-specific differences in the efficiency of particle selection. Both mussels and oysters, however, exhibited size-based rejection of PES microfibers, ingesting a higher proportion of shorter fibers than longer fibers. Polymer type did not impact selection of fibers or spheres. The relative size of particles (area and perimeter) was found to be the most important factor in predicting whether a MP will be rejected or ingested.
Subject(s)
Crassostrea , Mytilus edulis , Water Pollutants, Chemical , Animals , Mytilus edulis/chemistry , Microplastics , Crassostrea/chemistry , Plastics , Polystyrenes , Nylons , EatingABSTRACT
Reticence toward COVID-19 vaccination is more prevalent among women, people with low income, people who feel close to parties on the Far Right and Far Left and people who feel close to no party at all. It illustrates a mistrust of state institutions and policy-makers in general. The arguments in favor of Covid vaccine refusal are safety concern, and the contention that COVID is a mild disease. That said, vaccine hesitancy is vaccine-specific, with a major difference between Pfizer/Moderna and Oxford-AstraZeneca vaccines. Aside from vaccine hesitancy, vaccination intention rate has approached 80%.
Subject(s)
COVID-19 Vaccines , COVID-19 , Adult , Female , Humans , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination , Vaccination Refusal , IntentionABSTRACT
INTRODUCTION: The effect of SARS-CoV-2 severity or the trimester of infection in pregnant mothers, placentas, and infants is not fully understood. METHODS: A retrospective, observational cohort study in Chapel Hill, NC of 115 mothers with SARS-CoV-2 and singleton pregnancies from December 1, 2019 to May 31, 2021 via chart review to document the infants' weight, length, head circumference, survival, congenital abnormalities, hearing loss, maternal complications, and placental pathology classified by the Amsterdam criteria. RESULTS: Of the 115 mothers, 85.2% were asymptomatic (n = 37) or had mild (n = 61) symptoms, 13.0% had moderate (n = 9) or severe (n = 6) COVID-19, and 1.74% (n = 2) did not have symptoms recorded. Moderate and severe maternal infections were associated with increased C-section, premature delivery, infant NICU admission, and were more likely to occur in Type 1 (p = 0.0055) and Type 2 (p = 0.0285) diabetic mothers. Only one infant (0.870%) became infected with SARS-CoV-2, which was not via the placenta. Most placentas (n = 63, 54.8%) did not show specific histologic findings; however, a subset showed mild maternal vascular malperfusion (n = 26, 22.6%) and/or mild microscopic ascending intrauterine infection (n = 28, 24.3%). The infants had no identifiable congenital abnormalities, and all infants and mothers survived. DISCUSSION: Most mothers and their infants had a routine clinical course; however, moderate and severe COVID-19 maternal infections were associated with pregnancy complications and premature delivery. Mothers with pre-existing, non-gestational diabetes were at greatest risk of developing moderate or severe COVID-19. The placental injury patterns of maternal vascular malperfusion and/or microscopic ascending intrauterine infection were not associated with maternal COVID-19 severity.
Subject(s)
COVID-19 , Pregnancy Complications, Infectious , Premature Birth , Female , Humans , Immunoglobulin G , Infant , Infectious Disease Transmission, Vertical , Mothers , Placenta/pathology , Pregnancy , Pregnancy Complications, Infectious/pathology , Premature Birth/epidemiology , Premature Birth/pathology , Retrospective Studies , SARS-CoV-2ABSTRACT
INTRODUCTION: The Banned Drinker Register (BDR) was reintroduced in the Northern Territory (NT) in September 2017. The BDR is a supply reduction measure and involves placing people who consume alcohol at harmful levels on a register prohibiting the purchase, possession and consumption of alcohol. The current study aims to evaluate the impacts of the reintroduction of the BDR, in the context of other major alcohol policy initiatives introduced across the NT such as Police Auxiliary Liquor Inspectors and a minimum unit price for alcohol of US$1.30 per standard drink. METHODS AND ANALYSES: The Learning from Alcohol (policy) Reforms in the Northern Territory project will use a mixed-methods approach and contain four major components: epidemiological analysis of trends over time (outcomes include health, justice and social welfare data); individual-level data linkage including those on the BDR (outcomes include health and justice data); qualitative interviews with key stakeholders in the NT (n≥50); and qualitative interviews among people who are, or were previously, on the BDR, as well as the families and communities connected to those on the BDR (n=150). The impacts of the BDR on epidemiological data will be examined using time series analysis. Linked data will use generalised mixed models to analyse the relationship between outcomes and exposures, utilising appropriate distributions. Qualitative data will be analysed using thematic analysis. ETHICS AND DISSEMINATION: Ethics approvals have been obtained from NT Department of Health and Menzies School of Health Research Human Research Ethics Committee (HREC), Central Australia HREC and Deakin University HREC. In addition to peer-reviewed publications, we will report our findings to key organisational, policy, government and community stakeholders via conferences, briefings and lay summaries.
Subject(s)
Alcoholic Beverages , Ethanol , Health Policy , Humans , Northern Territory/epidemiology , Research DesignABSTRACT
BACKGROUND: Endoscopic sinus surgery (ESS) is a common operation for patients with chronic rhinosinusitis with nasal polyps (CRSwNP) when medical therapy alone is insufficient. No randomised controlled trials on the efficacy of ESS have been published. We aimed to assess the efficacy of ESS plus medical therapy versus medical therapy alone in patients with CRSwNP. METHODS: We performed an open-label, multicentre, pragmatic, randomised, controlled trial in three tertiary care centres and 12 secondary care centres in 11 cities in the Netherlands (Almere, Amstelveen, Amsterdam, Blaricum, Den Haag, Deventer, Haarlem, Hoofddorp, Hoorn, Leiderdorp, and Rotterdam). Adults (aged ≥18 years) with CRSwNP and an indication for ESS were randomly assigned (1:1) using block randomisation (block sizes of six), stratified by study centre, to receive either ESS plus medical therapy or medical therapy. ESS was performed according to local practice, although anterior ethmoidectomy was mandatory. Medical therapy was prescribed at the patient's otorhinolaryngologist's discretion, and could be, but was not limited to, nasal corticosteroids, nasal rinsing, systemic corticosteroids, or systemic antibiotics. The primary outcome was disease-specific health-related quality of life (HRQoL) at 12 months of follow up, measured with the validated Sinonasal Outcome Test 22 (SNOT-22; where each item is scored from 0 to 5, where 0 indicated no problems and 5 indicates problems as bad as can be, with a total score of 0-110 points), and the minimal clinically important difference of the SNOT-22 is 9·0 points. Primary and safety analyses were performed on an intention-to-treat (ITT) basis. The ITT population comprised all patients who were randomly assigned to treatment according to their randomisation group and without any protocol violation. This study is registered with the Netherlands Trial Register, NTR4978, and is ongoing. FINDINGS: Between Feb 15, 2015, and Aug 27, 2019, 371 patients were screened for eligibility, of whom 238 were eligible, willing to participate, and randomly assigned to ESS plus medical therapy (n=121) or medical therapy (n=117) and 234 were included in the baseline ITT population (n=118 ESS plus medical therapy; n=116 medical therapy). 142 (61%) of 234 patients at baseline were men and 92 (39%) were women, and the mean age was 50·4 years (SD 12·7). 206 participants were analysed at 12 months for the primary outcome (n=103 in the ESS plus medical therapy group; n=103 in the medical therapy group). At 12 months follow-up, the mean SNOT-22 score in the ESS plus medical therapy group was 27·9 (SD 20·2; n=103) and in the medical therapy group was 31·1 (20·4; n=103), with an adjusted mean difference of -4·9 (95% CI -9·4 to -0·4), favouring ESS plus medical therapy. Adverse events were similar between the groups. The most common adverse events were minor epistaxis or gastrointestinal problems. No treatment-related deaths occurred, but one patient died due to congestive heart failure. INTERPRETATION: ESS plus medical therapy is more efficacious than medical therapy alone in patients with CRSwNP, although the minimal clinically important difference was not met. Long-term follow-up data are needed to determine whether the effect persists. The current results are a basis for further development of evidence-based guidelines. FUNDING: The Netherlands Organisation for Health Research and Development (ZonMw).