Exploring the fate of cattle herds with inconclusive reactors to the tuberculin skin test

Bovine tuberculosis (TB) is an important animal health issue in many parts of the world. In England and Wales, the primary test to detect infected animals is the single intradermal comparative cervical tuberculin test, which compares immunological responses to bovine and avian tuberculins. Inconclusive test reactors (IRs) are animals that demonstrate a positive reaction to the bovine tuberculin only marginally greater than the avian reaction, so are not classified as reactors and immediately removed. In the absence of reactors in the herd, IRs are isolated, placed under movement restrictions and re-tested after 60 days. Other animals in these herds at the time of the IR result are not usually subject to movement restrictions. This could affect efforts to control TB if undetected infected cattle move out of those herds before the next TB test. To improve our understanding of the importance of IRs, this study aimed to assess whether median survival time and the hazard of a subsequent TB incident differs in herds with only IRs detected compared with negative-testing herds. Survival analysis and extended Cox regression were used, with herds entering the study on the date of the first whole herd test in 2012. An additional analysis was performed using an alternative entry date to try to remove the impact of IR retesting and is presented in the Supplementary Material. Survival analysis showed that the median survival time among IR only herds was half that observed for clear herds (2.1 years and 4.2 years respectively; p < 0.001). Extended Cox regression analysis showed that IR-only herds had 2.7 times the hazard of a subsequent incident compared with negative-testing herds in year one (hazard ratio: 2.69; 95% CI: 2.54, 2.84; p < 0.001), and that this difference in the hazard reduced by 63% per year. After 2.7 years the difference had disappeared. The supplementary analysis supported these findings showing that IR only herds still had a greater hazard of a subsequent incident after the IR re-test, but that the effect was reduced. This emphasizes the importance of careful decision making around the management of IR animals and indicates that re-testing alone may not be sufficient to reduce the risk posed by IR only herds in England and Wales

Physical fitness components associated with performance in a multiple-sprint test.

PURPOSE: The 5-m repeat-sprint test (5-m RST) measures resistance to fatigue after repeated bouts of short-duration, high-intensity activity. This study determined the components of fitness associated with performance in 5-m RSTs. METHODS: Speed (10-m and 40-m sprints), strength (bench press), agility, strength endurance (pull-ups and push-ups), and aerobic power (20-m shuttle-run test) were measured in male provincial- or national-level rugby (n = 110), hockey (n = 59), and soccer (n = 55) players. RESULTS: Subjects with either high (HI) or low (LO) resistance to fatigue in the 5-m RST differed in body mass (76.9 +/- 11.6 kg vs 102.1 +/- 18.9 kg, HI vs LO, respectively, P < .001), agility (14.55 +/- 0.41 seconds vs 15.56 +/- 0.30 seconds, P < .001), bench press (86 +/- 20 kg vs 114 +/- 33 kg, P = .03), pull-ups (13 +/- 4 vs 8 +/- 5, P = .02), push-ups (56 +/- 12 vs 39 +/- 13, P = .002), and 20-m shuttle-run test (20-m SRT; 133 +/- 11 vs 87 +/- 12 shuttles, P < .001). Body mass, strength, and aerobic power were the best predictors of 5-m RST performance: 5-m RST = -1.274(mass) + 0.756(1RM bench press) + 2.053(number of 20-m SRT shuttles) + 549.409 (R2 = .66). CONCLUSIONS: Performance in the 5-m RST is predicted best by a combination of factors including body mass, strength, and aerobic ability, rather than by any single component of fitness

Early-Life Obesity Prevention: Critique of Intervention Trials During the First One Thousand Days

Purpose of review - To critique the evidence from recent and ongoing obesity prevention interventions in the first 1000 days in order to identify evidence gaps and weaknesses, and to make suggestions for more informative future intervention trials. Recent findings - Completed and ongoing intervention trials have had fairly modest effects, have been limited largely to high-income countries, and have used relatively short-term interventions and outcomes. Comparison of the evidence from completed prevention trials with the evidence from systematic reviews of behavioral risk factors shows that some life-course stages have been neglected (pre-conception and toddlerhood), and that interventions have neglected to target some important behavioral risk factors (maternal smoking during pregnancy, infant and child sleep).Finally, while obesity prevention interventions aim to modify body composition, few intervention trials have used body composition measures as outcomes, and this has limited their sensitivity to detect intervention effects. The new WHO Healthy Lifestyles Trajectory (HeLTI) initiative should address some of these weaknesses. Summary - Future early obesity prevention trials should be much more ambitious. They should, ideally: extend their interventions over the first 1000 days; have longer-term (childhood) outcomes, and improved outcome measures (body composition measures in addition to proxies for body composition such as the BMI for age); have greater emphasis on maternal smoking and child sleep; be global

Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis

Postpartum psychosis is defined as a psychotic episode occurring within 4 to 6  weeks of childbirth. While there is robust evidence that adverse life events are associated with the onset and relapse of psychosis outside the postpartum period, the extent to which these contribute to postpartum psychosis is less clear. This systematic review examined whether adverse life events are associated with an increased likelihood of developing postpartum psychosis or subsequent relapse in women diagnosed with postpartum psychosis. The following databases were searched from inception to June 2021: MEDLINE, EMBASE, PsycInfo. Study level data were extracted including setting, number of participants, type of adverse event, and differences between groups. A modified version of the Newcastle-Ottawa Quality Assessments Scale was used to assess risk of bias. In total, 1933 records were identified, of which 17 met the inclusion criteria, comprising nine case–control studies and eight cohort studies. Most studies (16/17) examined the association between adverse life events and the onset of postpartum psychosis, with only in which the outcome was relapse of psychosis. Overall, there were 63 different measures of adversity examined (most of which were examined in a single study only) and 87 associations between these measures and postpartum psychosis tested across the studies. In terms of statistically significant associations with onset/relapse of postpartum psychosis, 15 (17%) were positive (i.e., the adverse event increased the risk of onset/relapse), 4 (5%) were negative, and 68 (78%) were not statistically significant. Our review highlights the diversity of risk factors examined in this field, with few attempts at replication, hence limiting the ability to conclude that any single risk factor is robustly associated with the onset of postpartum psychosis. Further large-scale studies, that attempt to replicate earlier studies, are urgently needed to determine whether adverse life events play a role in the onset and exacerbation of postpartum psychosis. Systematic review registration: [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260592], identifier [CRD42021260592]

Using geographically weighted regression to explore the spatially heterogeneous spread of bovine tuberculosis in England and Wales

An understanding of the factors that affect the spread of endemic bovine tuberculosis (bTB) is critical for the development of measures to stop and reverse this spread. Analyses of spatial data need to account for the inherent spatial heterogeneity within the data, or else spatial autocorrelation can lead to an overestimate of the significance of variables. This study used three methods of analysis—least-squares linear regression with a spatial autocorrelation term, geographically weighted regression (GWR) and boosted regression tree (BRT) analysis—to identify the factors that influence the spread of endemic bTB at a local level in England and Wales. The linear regression and GWR methods demonstrated the importance of accounting for spatial differences in risk factors for bTB, and showed some consistency in the identification of certain factors related to flooding, disease history and the presence of multiple genotypes of bTB. This is the first attempt to explore the factors associated with the spread of endemic bTB in England and Wales using GWR. This technique improves on least-squares linear regression approaches by identifying regional differences in the factors associated with bTB spread. However, interpretation of these complex regional differences is difficult and the approach does not lend itself to predictive models which are likely to be of more value to policy makers. Methods such as BRT may be more suited to such a task. Here we have demonstrated that GWR and BRT can produce comparable outputs

Long-term use of non-steroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population

BACKGROUND: Recent data indicate that chronic use of coxibs leads to an increased occurrence of thrombotic cardiovascular events. This raises the question as to whether traditional non-steroidal anti-inflammatory drugs (tNSAIDs) might also produce similar hazards. Our aim has been to evaluate the association between the chronic use of tNSAIDs and the risk of myocardial infarction (MI) in patients. METHODS: We performed a nested case-control analysis with 4,975 cases of acute MI and 20,000 controls, frequency matched to cases by age, sex, and calendar year. RESULTS: Overall, current use of tNSAID was not associated with an increased risk of MI (RR:1.07;95%CI: 0.95–1.21). However, we found that the relative risk (RR) of MI for durations of tNSAID treatment of >1 year was 1.21 (95% CI, 1.00–1.48). The corresponding RR was 1.34 (95% CI, 1.06–1.70) for non-fatal MI. The effect was independent from dose. The small risk associated with long-term use of tNSAIDs was observed among patients not taking low-dose aspirin (RR: 1.29; 95% CI, 1.01–1.65). The effect of long-term use for individual tNSAIDs ranged from a RR of 0.87 (95% CI, 0.47–1.62) with naproxen to 1.38 (95% CI, 1.00–1.90) with diclofenac. CONCLUSION: This study adds support to the hypothesis that chronic treatment with some tNSAIDs is associated with a small increased risk of non-fatal MI. Our data are consistent with a substantial variability in cardiovascular risks between individual tNSAIDs

Herd-level risk factors of bovine tuberculosis in England and Wales after the 2001 foot-and-mouth disease epidemic

We present the results of a 2005 case–control study of bovine tuberculosis (bTB) breakdowns in English and Welsh herds. The herd management, farming practices, and environmental factors of 401matched pairs of case and control herds were investigated to provide a picture of herd-level risk factors in areas of varying bTB incidence. A global conditional logistic regression model, with region-specific variants, was used to compare case herds that had experienced a confirmed bTB breakdown to contemporaneous control herds matched on region, herd type, herd size, and parish testing interval. Contacts with cattle from contiguous herds and sourcing cattle from herds with a recent history of bTB were associated with an increased risk in both the global and regional analyses. Operating a farm over several premises, providing cattle feed inside the housing, and the presence of badgers were also identified as significantly associated with an increased bTB risk. Steps taken to minimize cattle contacts with neighboring herds and altering trading practices could have the potential to reduce the size of the bTB epidemic. In principle, limiting the interactions between cattle and wildlife may also be useful; however this study did not highlight any specific measures to implement