Helicobacter pylori genome variability in a framework of familial transmission

<p>Abstract</p> <p>Background</p> <p><it>Helicobacter pylori </it>infection is exceptionally prevalent and is considered to be acquired primarily early in life through person-to-person transmission within the family. <it>H. pylori </it>is a genetically diverse bacterial species, which may facilitate adaptation to new hosts and persistence for decades. The present study aimed to explore the genetic diversity of clonal isolates from a mother and her three children in order to shed light on <it>H. pylori </it>transmission and host adaptation.</p> <p>Results</p> <p>Two different <it>H. pylori </it>strains and strain variants were identified in the family members by PCR-based molecular typing and sequencing of five loci. Genome diversity was further assessed for 15 isolates by comparative microarray hybridizations. The microarray consisted of 1,745 oligonucleotides representing the genes of two previously sequenced <it>H. pylori </it>strains. The microarray analysis detected a limited mean number (± standard error) of divergent genes between clonal isolates from the same and different individuals (1 ± 0.4, 0.1%, and 3 ± 0.3, 0.2%, respectively). There was considerable variability between the two different strains in the family members (147 ± 4, 8%) and for all isolates relative to the two sequenced reference strains (314 ± 16, 18%). The diversity between different strains was associated with gene functional classes related to DNA metabolism and the cell envelope.</p> <p>Conclusion</p> <p>The present data from clonal <it>H. pylori </it>isolates of family members do not support that transmission and host adaptation are associated with substantial sequence diversity in the bacterial genome. However, important phenotypic modifications may be determined by additional genetic mechanisms, such as phase-variation. Our findings can aid further exploration of <it>H. pylori </it>genetic diversity and adaptation.</p

Helicobacter pylori infection among children in Sweden

Since Helicobacter pylori was first identified in 1983 convincing data has linked the infection to the development of gastritis and peptic ulcer disease and H. pylori has further been implicated in gastric carcinogenesis. Evidence suggests that H. pylori is one of the most common bacterial infections world-wide, and Aldhood seems to be the critical time for acquisition although the exact routes of transmission remain elusive. The aims of the present studies were to identify the age of acquisition of H. pylon infection among children in Sweden and to identify risk factors for the infection. We further wanted to elucidate the possible role of H. pylori infection on gastrointestinal (GI) symptoms in children at school age. The non-invasive diagnostic methods for H. pylori infection used in the studies were validated. A seroepidepidemiological follow-up of 294 Swedish-born children (having Swedishborn parents) from 6 months to 11 years revealed the highest incidence rate of 13 new infections per 100 child-years for the period between 18 and 24 months. This resulted in a prevalence of 10% in the 2-year-olds. Transient infections were found to be common, resulting in an overall decline of the prevalence to 3 % in the 11-year-olds. A cross-sectional community-based study of 695 10-12-year-old children (response rate 81%) confirmed the low seroprevalence among children with parents born in Scandinavia. Major differences in H. pylon prevalence were seen among Swedish children of different ethnic origin indicating that exposure opportunity within the family is a strong determinant for childhood H. pylori infection. Low socio-economic status and large family size were independent risk factors for infection among children with appreciable exposure opportunity at home. Also the time spent by the child in the country of origin seemed to matter for the risk of contracting the infection early in life. Close contacts between children outside the family, such as those at day-care centres and in school classes with a high H. pylori prevalence, did not increase the risk of H. pylori infection, pointing at intrafamilial transmission as the major route of transmission in the present setting. Also, intrafamilial transmission of H. pylori infection seemed to be dominated by mother-to-child transmission. Use of antibiotics during childhood did not decrease the prevalence of H. pylori infection. H. pylori infection was not found to be associated with an increased risk of recurrent abdominal pain (RAP) or GI symptom among school children. However, the possibly more virulent Type 1 strain (CagA+ and VacA+) infections were strongly and inversely associated with abdominal pain and reflux symptoms, while Type 2 infected children seemed to be at increased risk for having reflux symptoms, RAP and weekly abdominal pain. Serology by ELISA and Immunoblot, as well as 13C-UBT, were demonstrated to be useful diagnostic methods for H. pylori infection in children provided that adjusted cut-offs are used. The presence of specific H. pylori immunoreactive bands (as measured by Immunoblot) seemed to vary according to geographic origin also for children living in the same country

Poor School-Related Well-Being among Adolescents with Disabilities or ADHD

Poor school-related well-being may influence adolescents' school performance and lifestyle. Adolescents having disabilities or ADHD are in a vulnerable situation for having poor school-related well-being, compared to adolescents not having disabilities. We used cross-sectional data from a school-based survey among 15-18-year-olds (N = 4071) in Sormland, Sweden, to analyse the association between poor school-related well-being and disabilities or ADHD. The analyses were carried out by logistic regression models, adjusting for background factors, school-related factors, and health-compromising behaviours. Adolescents having disabilities (n = 827) or ADHD (n = 146) reported that their disability had a negative influence on school. Compared to peers without disability, those having disabilities had an increased chance (OR = 1.40 95% CI: 1.17-1.68) of poor school-related well-being. The corresponding OR was doubled for adolescents reporting ADHD (2.23 95% CI: 1.56-3.18). For the ADHD group, the adjOR for poor school-related well-being remained significant (1.67 95% CI: 1.13-2.50) after adjustments for school-related factors and health-compromising behaviours, but not for the disability group. In conclusion, adolescents having ADHD are a particularly vulnerable group at school, having a greater risk of poor school-related well-being. Schools should actively work to achieve school satisfaction for adolescents having disabilities, to ensure that all students have similar opportunities for favourable development, health and achievement of their academic goals

The Association between Adolescents’ Experiences of Close Relatives Having Severe Health Conditions and Their Own Mental Health—A Population-Based School Study

Adolescents with close relatives having severe health conditions or who have died (RSHC) are vulnerable, and this has long-term influences on their lives and health. This study investigated how adolescents with RSHC experiences reported having poor mental health and protective factors and the combined influence of these compared to their peers who had not had these experiences. A cross-sectional school-based survey among students aged 15–18 years (N = 3410) in Sörmland, Sweden, was used to analyse the association between poor mental health and experiences from having one or several RSHC experiences with physical illness, mental illness, or substance abuse/gambling disorder, as well as having relatives who have died. Logistic regression models were performed, adjusting for background factors, and protective factors against poor mental health related to school, home relations, safety in everyday life, and lifestyle were assessed. Adolescents with one RSHC experience had an OR of 1.45 (95% CI: 1.23–1.72) for poor mental health, and those with several RSHC experiences had an OR of 2.35 (95% CI: 1.94–2.84) compared to those with no RSHC experiences. The greatest OR for poor mental health was seen among adolescents with the combination of several RSHC experiences and few protective factors against poor mental health (18.83; 95% CI: 11.86–29.91). Adolescents with RSHC experiences have increased odds of poor mental health compared to adolescents without these experiences, especially those with several RSHC experiences and few protective factors. When meeting adolescents with RSHC experiences, supporting their key protective factors may play an important role in improving mental health

High risk of severe child abuse and poly-victimisation in families with parental substance misuse : results from a Swedish school-based survey

Child abuse is a widespread public health problem, potentially leading to long-term consequences for the exposed individuals and society. By learning more about the major risk factors, child abuse can be prevented. The objective of this study was to examine the pattern and severity of maltreatment in adolescents reporting parental alcohol and/or other drug problems. Cross-sectional data from a Swedish national school survey including 4,741 pupils (15- and 17-year-olds) conducted in 2016 were analysed using univariate tests (chi-squared) and binomial logistic regression models. Results showed that parental alcohol or other drug misuse, reported by the adolescents, was significantly associated with all types of child maltreatment. There was a particularly increased risk of severe child abuse, including witnessing recurrent physical intimate partner violence (adjusted odds ratio (adj. OR) 11.01; confidence interval (CI) 6.61-18.35) and poly-victimisation (adj. OR 7.82; CI 5.50-11.13), in families with parental alcohol and/or other drug problems compared to families without these problems. These results call for preventive measures, such as restrictive alcohol and drug policies, and early recognition of alcohol or other drug misuse among parents. In addition, professionals working with children and with substance-using parents need to identify and support these children

Unintentional Injuries Are Associated with Self-Reported Child Maltreatment among Swedish Adolescents

Injuries constitute a large share of childhood morbidity and mortality. This study examines whether adolescents with self-reported experiences of different types of child maltreatment more frequently reported unintentional injury events requiring health- or dental care during the last year and/or hospitalization at any time during childhood. Cross-sectional data from a Swedish national representative school survey (2016) including 4741 adolescents were used (78.5% response rate). Data were analyzed with univariate tests and multiple logistic regression. Statistically significant associations between reported experiences of physical, psychological and sexual abuse, neglect, and witnessing partner violence during childhood and reported unintentional injuries requiring health- or dental care during the last year were found (aOR:s between 1.39-1.77). The corresponding association for poly-victimization was aOR 1.91 (95% CI 1.39-2.62). Furthermore, a linear-by-linear association was seen for degree of victimization and number of episodes of unintentional injuries that required care in the last year (p = 0.000), as well as lifetime hospitalizations (p = 0.000). This study shows significant associations between child maltreatment and unintentional injuries requiring health- and/or dental care and hospitalization. To improve both injury and child maltreatment prevention, healthcare professionals need to pay particular attention to children and adolescents who repeatedly seek healthcare services due to injurious events

Understanding adolescent males' poor mental health and health-compromising behaviours : A factor analysis model on Swedish school-based data

AIM: The aim was to develop a factor model of the clustering of poor mental-health symptoms and health-compromising behaviours (HCBs) in adolescent males. METHODS: The study was based on two cross-sectional school-based Swedish surveys in 2011 (response rate 80%, N=2823) and 2014 (response rate 85%, N=2358), both of which comprised questionnaires from males aged 15-16 and 17-18 years. A factor model was developed by exploratory factor analysis on the 2011 survey and validated by confirmatory factor analysis on the 2014 survey. RESULTS: Four aspects of poor mental health and HCBs emerged in the exploratory factor analysis: (a) deviancy as a tendency to substance use and delinquency, (b) unsafety as an inclination towards feelings of unsafety in different environments, (c) gloominess as a tendency towards pessimism and feeling unwell and (d) pain as an inclination to experience physical pain. The model was validated with good model fit. Age did not affect the model structure, but older adolescent males were more influenced by deviancy and gloominess and less by unsafety compared to their younger peers. Conclusions: Separating symptoms of poor mental health and HCBs into four areas - deviancy, unsafety, gloominess and pain - brings new perspectives to the understanding of adolescent males' health. To the best of our knowledge, our factor model is the first to include unsafety and pain in this context. Whenever a comprehensive approach to the health of adolescent males is needed in the clinic or in the field of public health, this factor model may provide guidance

Perceived needs for team-based visits in Swedish child healthcare services exceed its existence : A mixed-methods study targeting healthcare professionals

AIM: To investigate both quantitatively and qualitatively the differences between participation in team-based visits (TBVs) and perceived needs for TBVs from the perspectives of healthcare professionals, in the context of the Swedish three-tier national Child Healthcare program. METHODS: A study-specific questionnaire, including multiple-choice questions with fixed and free-text response options, was developed, and used. To capture healthcare professionals' experiences and find explanations for the quantitative results in qualitative data, a convergent parallel mixed-methods study design was used. Descriptive statistics and McNemar's test were used to analyze the quantitative data, and content analysis was used to analyze the qualitative data. RESULTS: Healthcare professionals perceived the need for TBVs in the Swedish Child Healthcare Services (CHS) to a high extent. The largest difference between the perceived need for TBVs and experienced TBVs was for indications associated with psychosocial problems. The quantitative findings were explored by the qualitative findings. Both individual and organizational factors influenced TBVs. CONCLUSION: Perceived needs for TBVs in Swedish CHS exceed its existence. Healthcare professionals require TBVs delivered by interprofessional teams, in line with proportionate universalism. Accordingly, organizational structures (e.g., co-location and clear instructions on how to distribute TBVs) and human resources (e.g., psychologists and social worker) are needed

Confidentiality matters! Adolescent males’ views of primary care in relation to psychosocial health : a structural equation modelling approach

Objective: To investigate to what degree adolescent males (1) value confidentiality, (2) experience confidentiality and are comfortable asking sensitive questions when visiting a general practitioner (GP), and (3) whether self-reported symptoms of poor mental health and health-compromising behaviours (HCB) affect these states of matters. Design: Cross-sectional. Setting: School-based census on life, health and primary care in Region Sörmland, Sweden. Subjects: 2,358 males aged 15–17 years (response rate 84%). Main outcome measures: The impact of poor mental health and HCBs on adolescent males’ valuing and experiencing private time with the GP, having professional secrecy explained, and being comfortable asking about the body, love and sex, analysed with structural equation modelling. Results: Almost all respondents valued confidentiality regardless of their mental health or whetherthey engaged in HCBs: 86% valued spending private time with the GP, and 83% valued receivinga secrecy explanation. Among those who had visited a GP in the past year (n¼1,200), 74% had experienced private time and 42% a secrecy explanation. Three-quarters were at least partly comfortable asking sensitive questions. Adolescent males with HCBs were more likely to experience a secrecy explanation (approximative odds ratio [appOR] 1.26;p¼0.005) and to be comfortable asking about sex than their peers (appOR 1.22;p¼0.007). Respondents reporting experienced confidentiality were more comfortable asking sensitive questions (appOR 1.25–1.54;p0.010). Conclusion: Confidentiality matters regardless of poor mental health or HCBs and makes adolescent males more comfortable asking sensitive questions. We suggest that GPs consistently offerprivate time and explain professional secrecy. KEY POINTS Confidentiality for adolescent males has been scantily studied in relation to mental healthand health-compromising behaviours. In this study, most adolescent males valued confidentiality, regardless of their mental healthand health-compromising behaviours. Health-compromising behaviours impacted only slightly, and mental health not at all, on experiences of confidentiality in primary care. When provided private time and an explanation of professional secrecy, adolescent males were more comfortable asking the GP sensitive questions

Healthcare professionals' perceptions about interprofessional teamwork : a national survey within Swedish child healthcare services

Background: Globally, interprofessional teamwork is described as a key method to promote health and prevent illness in children, namely, to achieve the goals of Child Healthcare Services (CHS). However, how teamwork should be designed within CHS to achieve the goals is unclear. This study aimed to investigate healthcare professionals' perceptions about 1) taking part in interprofessional teamwork, 2) team characteristics, and 3) whether the perceptions were related to professional affiliation or workplace. Methods: A national cross-sectional survey was conducted using a web-based study-specific questionnaire sent to all accessible nurses, physicians, and psychologists in Swedish CHS (n = 3552). The response rate was 31.5%. To identify possible associations, logistic regressions were conducted. Results: Almost all respondents, 1096/1119 (97.9%), reported taking part in some type of interprofessional teamwork within the Swedish CHS. Among those, the most common was team-based visits (82.2%). It was perceived that performing team-based visits resulted in fulfilled goals, expertise exceeding individual team members' competences, provision of high-quality care, and meeting children's and families' needs, to a greater extent, than if not performing team-based visits. Correspondingly, working as a team in parental groups was perceived as resulting in fulfilled goals, meeting the needs of children and their families, and continuity within the team to a greater extent than if not working together in a team. Professional affiliation was associated with different perceptions and types of teamwork. Family Centers were positively associated with all types of teamwork as well as continuity within the team. Conclusions: Healthcare professionals' perceptions about team characteristics were associated with professional affiliation, workplace, and type of teamwork (defined as team activities) within the CHS. Professionals within Swedish CHS, taking part in team-based visits and in interprofessional teamwork in parental groups, perceived that the team fulfilled its goals and met the needs of children and families to a greater extent than professionals not taking part in these types of teamwork. Professionals at Family Centers were more likely to work in teams in different ways. Knowledge about interprofessional teamwork for individuals and groups in Swedish CHS might also be valuable in other healthcare settings, dealing with complex needs