Second-trimester maternal distress increases the risk of small for gestational age.

BACKGROUND: The effect of prenatal distress on the risk of a small for gestational age (SGA) infant is uncertain. We have addressed the influences of prenatal stress, anxiety and depression on the risk of SGA. We also examined the effects of infant sex and timing of distress during pregnancy on any observed associations. METHOD: The study population comprised 5606 healthy nulliparous pregnant women who participated in the international prospective Screening for Obstetric and Pregnancy Endpoints (SCOPE) study. Women completed the Perceived Stress Scale (PSS), the short form of the Spielberger State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at 15 ± 1 and 20 ± 1 weeks' gestation. SGA was defined as birthweight below the 10th customized percentile. Logistic regression was used for data analysis, adjusting for several potential confounders such as maternal age, body mass index (BMI), smoking, socio-economic status and physical exercise. RESULTS: The risk of SGA was increased in relation to mild [adjusted odds ratio (aOR) 1.35, 95% confidence interval (CI) 1.07-1.71], moderate (aOR 1.26, 95% CI 1.06-1.49), high (aOR 1.45, 95% CI 1.08-1.95) and very high stress scores (aOR 1.56, 95% CI 1.03-2.37); very high anxiety score (aOR 1.45, 95% CI 1.13-1.86); and very high depression score (aOR 1.14, 95% CI 1.05-1.24) at 20 ± 1 weeks' gestation. Sensitivity analyses showed that very high anxiety and very high depression increases the risk of SGA in males but not in females whereas stress increases the risk of SGA in both males and females. CONCLUSIONS: These findings suggest that prenatal stress, anxiety and depression measured at 20 weeks' gestation increase the risk of SGA. The effects of maternal anxiety and depression on SGA were strongest in male infants.

Oral Health in the Population Assessment of Tobacco and Health Study.

Tobacco use is a well-established risk factor for multiple adverse oral conditions. Few nationally representative oral health data sets encompass the current diversity of tobacco and nicotine products. This investigation examines the validity of oral health measures in the Population Assessment of Tobacco and Health (PATH) Study to assess relationships between tobacco use and oral health. Cross-sectional data from PATH Study wave 4 (N = 33,643 US adults, collected 2016-2018) were used to obtain estimates for 6 self-reported oral conditions (e.g., bone loss around teeth, tooth extractions) and compared with analogous estimates from the National Health and Nutrition Examination Survey (NHANES) cycle 2017-2018 (N = 5,856). Within the PATH Study, associations were calculated between tobacco use status and lifetime and past 12-mo experience of adverse oral conditions using survey-weighted multivariable logistic regression. Nationally representative estimates of oral conditions between the PATH Study and NHANES were similar (e.g., ever-experience of bone loss around teeth: PATH Study 15.2%, 95% CI, 14.4%-15.9%; NHANES 16.6%, 95% CI, 14.9%-18.4%). In the PATH Study, combustible tobacco smoking was consistently associated with lifetime and past 12-mo experience of adverse oral health (e.g., exclusive cigarette smoking vs. never tobacco use, adjusted odds ratio [AOR] for loose teeth in past 12 mo: 2.02; 95% CI, 1.52-2.69). Exclusive smokeless tobacco use was associated with greater odds of loose teeth (AOR, 1.93; 95% CI, 1.15-3.26) and lifetime precancerous lesions (AOR, 3.85; 95% CI, 1.73-8.57). Use of other noncigarette products (e.g., pipes) was inconsistently associated with oral health outcomes. PATH Study oral health measures closely align with self-reported measures from NHANES and are internally concurrent. Observed associations with tobacco use and the ability to examine emerging tobacco products support application of PATH Study data in dental research, particularly to examine potential oral health effects of novel tobacco products and longitudinal changes in tobacco use behaviors.

Effects of milk composition, stir-out time, and pressing duration on curd moisture and yield.

A study was undertaken to investigate the effects of milk composition (i.e., protein level and protein:fat ratio), stir-out time, and pressing duration on curd moisture and yield. Milks of varying protein levels and protein:fat ratios were renneted under normal commercial conditions in a pilot-scale cheese vat. During the syneresis phase of cheese making, curd was removed at differing times, and curd moisture and yield were monitored over a 22-h pressing period. Curd moisture after pressing decreased with longer stir-out time and pressing duration, and an interactive effect was observed of stir-out time and pressing duration on curd moisture and yield. Milk total solids were shown to affect curd moisture after pressing, which has implications for milk standardization; that is, it indicates a need to standardize on a milk solids basis as well as on a protein:fat basis. In this study, a decreased protein:fat ratio was associated with increased total solids in milk and resulted in decreased curd moisture and increased curd yield after pressing. The variation in total solids of the milk explains the apparent contradiction between decreased curd moisture and increased curd yield. This study points to a role for process analytic technology in minimizing variation in cheese characteristics through better control of cheesemilk composition, in-vat process monitoring (coagulation and syneresis), and post-vat moisture reduction (curd pressing). Increased control of curd composition at draining would facilitate increased control of the final cheese grade and quality.

Validation of a curd-syneresis sensor over a range of milk composition and process parameters.

An online visible-near-infrared sensor was used to monitor the course of syneresis during cheesemaking with the purpose of validating syneresis indices obtained using partial least squares, with cross-validation across a range of milk fat levels, gel firmness levels at cutting, curd cutting programs, stirring speeds, milk protein levels, and fat:protein ratio levels. Three series of trials were carried out in an 11-L cheese vat using recombined whole milk. Three factorial experimental designs were used, consisting of 1) 3 curd stirring speeds and 3 cutting programs; 2) 3 milk fat levels and 3 gel firmness levels at cutting; and 3) 2 milk protein levels and 3 fat:protein ratio levels, respectively. Milk was clotted under constant conditions in all experiments and the gel was cut according to the respective experimental design. Prediction models for production of whey and whey fat losses were developed in 2 of the experiments and validated in the other experiment. The best models gave standard error of prediction values of 6.6 g/100 g for yield of whey and 0.05 g/100 g for fat in whey, as compared with 4.4 and 0.013 g/100 g, respectively, for the calibration data sets. Robust models developed for predicting yield of whey and whey fat losses using a validation method have potential application in the cheese industry.

Effects of cutting intensity and stirring speed on syneresis and curd losses during cheese manufacture.

Recombined whole milk was renneted under constant conditions of pH, temperature, and added calcium, and the gel was cut at a constant firmness. The effects of cutting and stirring on syneresis and curd losses to whey were investigated during cheese making using a factorial design with 3 cutting modes designed to provide 3 different cutting intensity levels (i.e., total cutting revolutions), 3 levels of stirring speed, and 3 replications. These cutting intensities and stirring speeds were selected to give a wide range of curd grain sizes and curd shattering, respectively. Both factors affected curd losses, and correct selection of these factors is important in the cheesemaking industry. Decreased cutting intensity and increased stirring speed significantly increased the losses of fines and fat from the curd to the whey. Cutting intensities and stirring speeds in this study did not show significant effects on curd moisture content over the course of syneresis. Levels of total solids, fines, and fat in whey were shown to change significantly during syneresis. It is believed that larger curd particles resulting from low cutting intensities coupled with faster stirring speeds resulted in a higher degree of curd shattering during stirring, which caused significant curd losses.

Computer vision and color measurement techniques for inline monitoring of cheese curd syneresis.

Optical characteristics of stirred curd were simultaneously monitored during syneresis in a 10-L cheese vat using computer vision and colorimetric measurements. Curd syneresis kinetic conditions were varied using 2 levels of milk pH (6.0 and 6.5) and 2 agitation speeds (12.1 and 27.2 rpm). Measured optical parameters were compared with gravimetric measurements of syneresis, taken simultaneously. The results showed that computer vision and colorimeter measurements have potential for monitoring syneresis. The 2 different phases, curd and whey, were distinguished by means of color differences. As syneresis progressed, the backscattered light became increasingly yellow in hue for circa 20 min for the higher stirring speed and circa 30 min for the lower stirring speed. Syneresis-related gravimetric measurements of importance to cheese making (e.g., curd moisture content, total solids in whey, and yield of whey) correlated significantly with computer vision and colorimetric measurements.

Evaluating mid-infrared spectroscopy as a new technique for predicting sensory texture attributes of processed cheese.

The objective of this study was to investigate the potential application of mid-infrared spectroscopy for determination of selected sensory attributes in a range of experimentally manufactured processed cheese samples. This study also evaluates mid-infrared spectroscopy against other recently proposed techniques for predicting sensory texture attributes. Processed cheeses (n = 32) of varying compositions were manufactured on a pilot scale. After 2 and 4 wk of storage at 4 degrees C, mid-infrared spectra (640 to 4,000 cm(-1)) were recorded and samples were scored on a scale of 0 to 100 for 9 attributes using descriptive sensory analysis. Models were developed by partial least squares regression using raw and pretreated spectra. The mouth-coating and mass-forming models were improved by using a reduced spectral range (930 to 1,767 cm(-1)). The remaining attributes were most successfully modeled using a combined range (930 to 1,767 cm(-1) and 2,839 to 4,000 cm(-1)). The root mean square errors of cross-validation for the models were 7.4 (firmness; range 65.3), 4.6 (rubbery; range 41.7), 7.1 (creamy; range 60.9), 5.1 (chewy; range 43.3), 5.2 (mouth-coating; range 37.4), 5.3 (fragmentable; range 51.0), 7.4 (melting; range 69.3), and 3.1 (mass-forming; range 23.6). These models had a good practical utility. Model accuracy ranged from approximate quantitative predictions to excellent predictions (range error ratio = 9.6). In general, the models compared favorably with previously reported instrumental texture models and near-infrared models, although the creamy, chewy, and melting models were slightly weaker than the previously reported near-infrared models. We concluded that mid-infrared spectroscopy could be successfully used for the nondestructive and objective assessment of processed cheese sensory quality.

Mongoose rabies in the Caribbean.

Mongooses (Herpestes auropunctatus) have been introduced into most of the larger Caribbean islands, some notable exceptions being Dominica, Tobago, and Montserrat. Rabies in Caribbean mongooses is present in Puerto Rico, Cuba, the Dominican Republic (and presumably Haiti), and Grenada. Bat rabies is known on Cuba, Grenada, and Trinidad, although mongooses found on Trinidad are free of the disease. None of the other islands is known to have rabies, although it could be present in sequestered bat populations. All reported case numbers of mongoose rabies in the Caribbean are underestimates, and available information is at best incomplete and at times fragmentary. Nevertheless, data are presented from the four affected islands. Mongoose reduction campaigns have been undertaken on Cuba and Grenada. In Cuba strychnine sulfate inoculated into labeled eggs is used, whereas in Grenada sodium fluoroacetate (1080) has been used in boiled cowhide baits. Mongoose poisoning is unsatisfactory and ineffective in the long-term. Because many mongooses naturally exposed to rabies virus develop serum neutralizing antibodies and are considered to be immunized, possibly for life, vaccination in the wild has been under consideration since the mid-1970s. Early attempts to produce a pill coated with ERA vaccine for enteric absorption in mongooses were not very successful, but new modified vaccines and recombinant techniques hold considerable promise.

Assessment of the efficacy of an IgM-elisa and microscopic agglutination test (MAT) in the diagnosis of acute leptospirosis.

In a prospective study in Barbados between 1979 and 1989, 321 cases were diagnosed in 638 patients presenting at a hospital with symptoms of leptospirosis. Initial diagnosis was based on patient history and characteristic signs and symptoms. In 92 cases (29%), diagnosis was confirmed by isolation of organisms from the blood, urine, or dialysate fluid; in the remaining 229 cases (71%) diagnosis was confirmed by serology alone. Results of an IgM-ELISA and microscopic agglutination test (MAT) in cases with isolates and in non-leptospirosis cases were used to assess the sensitivity and specificity of the tests. The sensitivity of IgM detection by ELISA was 52% in the first acute-phase specimen, increasing to 89% and 93% in the second acute-phase and convalescent specimens, respectively. The specificity of the IgM-ELISA was high (> or = 94%) in all specimens. The sensitivity of the MAT was low (30%) in the first acute-phase specimen, increasing to 63% in the second acute-phase specimen and 76% in the convalescent specimen. The specificity of the MAT was > or = 97% in all specimens.

Thrombocytopenia in leptospirosis.

In a retrospective study undertaken to document the frequency of thrombocytopenia in cases of leptospirosis, 18 of 32 patients (56.3%) had a platelet count of 100 x 10(3)/mm3 or less. Renal failure occurred in 72.2% of thrombocytopenic patients and in 21.4% of patients with normal platelet counts. The association of thrombocytopenia and renal failure was significant (P less than 0.02). The common occurrence of thrombocytopenia and its association with acute renal failure in patients with leptospirosis has not previously been reported.

Penicillin therapy in icteric leptospirosis.

A prospective, controlled randomized study of penicillin therapy in icteric human leptospirosis was carried out between 1 October 1983 and 31 December 1986. Thirty-eight patients received intravenous crystalline penicillin for 5 days, while 41 assigned to a control group received intravenous fluids only. A comparison of the results of laboratory tests made on the day of admission revealed no significant differences between the 2 groups. There was no significant difference in time for defervescence, return of biochemical parameters to normal, incidence of iritis, or mortality in the 2 groups. Three patients (7.3%) in the control group and 1 patient (2.6%) in the treatment group died. The overall mortality rate was 5.9%. Leptospira were recovered from urine cultures in 6 control patients but from none of the treated patients' post-treatment cultures. We conclude that penicillin has little effect on clinical outcome in icteric leptospirosis.

Thrombocytopenia in leptospirosis: the absence of evidence for disseminated intravascular coagulation.

In a prospective study of human leptospirosis, thrombocytopenia was demonstrated in 54% of 24 cases. The only additional laboratory evidence suggestive of disseminated intravascular coagulation lay in a mild elevation of fibrinogen degradation products, but this occurred with equal frequency in nonthrombocytopenic patients. There is therefore no causal relationship between disseminated intravascular coagulation and the thrombocytopenia of human leptospirosis.

Evaluation of the polymerase chain reaction for early diagnosis of leptospirosis.

Early diagnosis of leptospirosis is important because severe leptospiral infection can run a fulminant course. The polymerase chain reaction (PCR) was evaluated for the detection of leptospires in clinical samples from patients with acute leptospiral infection. Blood and urine samples from 71 patients with leptospirosis were examined by PCR, culture or serology. Samples from 44 (62%) patients with the diagnosis of leptospirosis were positive by PCR as compared to 34 (48%) by culture. The presence of leptospires was demonstrated by PCR in 13 patients before the development of antibodies, as well as in two patients who were seronegative during their illness and at autopsy. Samples from 16 patients without leptospirosis were seronegative and culture negative, and also negative by PCR. We conclude that PCR is a rapid, sensitive and specific means of diagnosing leptospiral infection, especially during the first few days of the disease.

Prevalence of leptospirosis in Belize.

In a search for leptospirosis in Belize, at least one current case was diagnosed among 11 febrile hospital patients examined in a 2-week period in mid-1984. Sera from 440 survey subjects in 6 schools, 4 urban communities and 9 rural communities were examined for leptospiral antibodies by the microscopic agglutination test. 20 of 174 (11.5%) school pupils, 19 of 88 (22%) urban community subjects and 66/178 (37%) rural community subjects were positive at titres greater than or equal to 1:50, and 7.5%, 17% and 26%, respectively, were positive at greater than or equal to 1:100. Among all groups of survey subjects, serological reactions to antigens in the Australis serogroup predominated. Up to 81% of 155 sera from cattle in various areas of Belize were positive at titres greater than or equal to 1:100. Serological reactions to serogroup Sejroe predominated (43%), followed by Pyrogenes (16%) and Australis (15%). 20 of 71 (28%) pig sera were positive at greater than or equal to 1:100, predominantly to serovars in the Australis serogroup (51%). Of 162 sheep or goat sera examined, 65 (40%) were positive at greater than or equal to 1:100, mainly to serogroup Autumnalis (25%), followed by Australis (15%).

A serosurvey for leptospirosis in Trinidad among urban and rural dwellers and persons occupationally at risk.

A survey for leptospiral antibodies was made of 1,375 persons in northern Trinidad between mid-1977 and mid-1978. The subjects were employees in seven occupational categories thought to entail a high risk of exposure to leptospires, and members of the general population of three rural and two urban communities. They were questioned inter alia about their leisure and occupational activities, household water supply and effluent, and contact with animals. Leptospiral infection was found to be widespread in the general population but not primarily associated with employment. Among the occupational groups the highest prevalence of antibodies was found in sugar-cane workers (45% infected), while among the communities prevalence was highest in the rural village of Cacandee (37%) and lowest in Woodbrook (Port-of-Spain) (5%). Keeping cattle, hunting and walking barefoot in the countryside were significantly associated with leptospiral serology. Over-all, serogroups Icterohaemorrhagiae and Autumnalis each accounted for about 25% of the seropositives in the general population. Among the occupational groups Autumnalis was the most commonly found (36%). It accounted for 42% of the seropositive sugar-cane workers and 57% of the seropositive rice farmers.

Leptospirosis in Trinidad and Grenada, with special reference to the mongoose.

In Trinidad, six Leptospira isolates were made from 957 febrile patients between 1968 amd 1972. In addition, CF antibodies were detected in 6-6% of febrile patients and human survey sera collected during this period. In 1972 alone, 10-4% (38/363) of sera examined had CF titres consistent with positive exposure to the disease. Grenada does not report leptospirosis, but the disease is common in mongooses in both Trinidad and Grenada. Serogroups Icterohaemorrhagiae, Pomona and Canicola are present in Grenada with 35-2% of mongooses examined being seropositive. Five Canicola strains of Leptospira were isolated from mongooses in Trinidad and serological studies showed that this was the most common serogroup from mongooses on the island. A total of 31 strains recorded from at least seven different serogroups and eight named serotypes have been isolated from humans, rats and mongooses in Trinidad. Human leptospirosis is probably more common in the Caribbean than the medical records indicate.

The prevalence of severe leptospirosis among humans on Barbados.

Leptospirosis was confirmed by the Leptospira Laboratory in 138 hospital patients on Barbados between early November 1979 and the end of 1982 (annual average 43.6 cases). These were the great majority of severe cases occurring on the island during that time. The crude incidence rate ranged between 15 and 23 per 100,000 population per year (average 17.6). 26 of the patients died (15 males, 11 females), giving an over-all case fatality rate of 18.8%, and an average of 8.2 deaths per year. 68% of all cases were in males. The highest percentages of cases were in males aged 20 to 24 and females aged 55 to 59, but the incidence of the disease in both sexes increased with age up to 60 years. Previous figures recorded on the island by the Ministry of Health for 1975-79 were considerably lower, with a mean of 23.6 cases per year and a crude annual incidence of 9.5 per 100,000. 15 of the patients died (13 males, 2 females), giving an over-all case fatality rate of 12.7% and an average of 3 deaths per year. 74% of all cases were in males. The highest percentages of cases were in the 20 to 29 and 50 to 59 year age groups for males and females, respectively, i.e., similar to those in the present series. In both sexes the incidence of leptospirosis increased with age up to 60 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Leptospirosis in patients from Grenada, West Indies.

Evidence of leptospirosis in humans from Grenada, W.I., is reported here for the first time. Of 139 hospital patients with pyrexia of undetermined origin, 94 were jaundiced, and 16 (17%) of these were positive for hepatitis B antigen (HBsAg) and not examined further. 20 of the remaining 123 (16%) febrile patients were positive for leptospiral antibodies; 11 of them were current or recent cases. 25 of 182 (14%) afebrile out-patients showed evidence of previous exposure to leptospiral organisms. The most frequently encountered serogroups in the 45 seropositive in- and out-patients were Icterohaemorrhagiae (38%), Panama (24%) and Canicola (11%).

Rabies serum neutralizing antibody in mongooses from Grenada.

During a four-year study on Grenada, 4,754 mongooses were examined, of which 100 (2.1%) were rabid. Of 1,675 mongooses tested for rabies serum neutralizing (SN) antibody, 498 (30%) were positive. During these four years (1971-74) the antibody prevalence rate increased from 20.8% to 43.2%, whereas the number of rabid mongooses decreased from 3.5% to 0.6%. Naturally acquired antibody was monitored in 20 captive mongooses for up to 35 months, and it was still circulating in 18 when monitoring ceased. The highest titre recorded was 1:1,400, and the rate of fall was greatest in mongooses with high initial titres. High titres of naturally acquired antibody suggest recent rabies activity. 14 mongooses vaccinated parenterally with 1.0 ml of attenuated ERA vaccine showed substantial increases in antibody titres; most had titres greater than 1:1,000 one month later and maintained a high titre for several months. The highest recorded was 1:34,800. The virus titres of brain material from rabid mongooses ranged from 10(1.8) to 10(4.3) and, in some cases, were only slightly lower than those of salivary gland tissue (range, 10(1) to 10(5.6).

Serological studies on leptospirosis in livestock and chickens from Grenada and Trinidad.

Sera from 1,206 livestock animals and chickens on Grenada and Trinidad were tested for leptospiral antibodies by the microscopic agglutination test. 376 of the sera were positive (25% of those tested on Grenada and 44% on Trinidad). The positive sera were obtained from 25% of 324 cattle, 35% of 130 pigs, 35% of 146 sheep, 25% of 44 goats and 11% of 175 chickens on Grenada; and 92% of 26 cattle, 53% of 122 pigs, 76% of 87 horses and donkeys and 11% of 144 chickens on Trinidad. Eight sera from ducks and geese on Trinidad were tested and found to be negative. The serogroups most commonly found to react with the sera of the Grenadian animals were Autumnalis, Icterohaemorrhagiae, Hebdomadis and the related serogroups Sejroe and Mini, and Pyrogenes; in the Trinidadian animals they were Icterohaemorrhagiae, Autumnalis, Hebdomadis and its related serogroups, and Panama. Strains of serogroup Pomona do not appear to have become established as livestock pathogens on the islands.