Exclusive breastfeeding duration and infant infection

BACKGROUND/OBJECTIVES: We estimated the risk of infection associated with the duration of exclusive breastfeeding (EBF). SUBJECT/METHODS: We analysed the data on 15 809 term, singleton infants from the UK Millennium Cohort Study. Infants were grouped according to months of EBF: never, <2, 2-4, 4-6 and 6 (the latter being World Health Organisation (WHO) policy since 2001: 'post-2001 WHO policy'). Among those EBF for 4-6 months, we separated those who started solids, but not formula, before 6 months, and were still breastfeeding at 6 months (that is, WHO policy before 2001: 'pre-2001 WHO policy'), from other patterns. Outcomes were infection in infancy (chest, diarrhoeal and ear). RESULTS: EBF was not associated with the ear infection, but was associated with chest infection and diarrhoea. EBF for <4 months was associated with a significantly increased risk of chest infection (adjusted risk ratios (RR) 1.24-1.28) and diarrhoea (adjusted RRs 1.42-1.66) compared with the pre-2001 WHO policy. There was an excess risk of the chest infection (adjusted RR 1.19, 95% confidence interval (CI): 0.97-1.46) and diarrhoea (adjusted RR 1.66, 95% CI: 1.11, 2.47) among infants EBF for 4-6 months, but who stopped breastfeeding by 6 months, compared with the pre-2001 WHO policy. There was no significant difference in the risk of chest infection or diarrhoea in those fed according to the pre-2001 versus post-2001 WHO policy. CONCLUSIONS: There is an increased risk of infection in infants EBF for <4 months or EBF for 4-6 months who stop breastfeeding by 6 months. These results support current guidelines of EBF for either 4-6 or 6 months, with continued breastfeeding thereafter.European Journal of Clinical Nutrition advance online publication, 27 July 2016; doi:10.1038/ejcn.2016.135

Comparison of OCT and HRT Findings Among Normal, Normal Tension Glaucoma, and High Tension Glaucoma

Purpose: To evaluate the relationship between optic disc and retinal nerve fiber layer (RNFL) measurements obtained with the optical coherence tomography (OCT) and the Heidelberg retina topography (HRT) in normal, normal tension glaucoma (NTG), and high tension glaucoma (HTG). Methods: Normal, NTG and HTG subjects who met inclusion and exclusion criteria were evaluated retrospectively. One hundred seventy eyes of 170 patients (30 normal, 40 NTG, and 100 HTG) were enrolled. Complete ophthalmologic examination, HRT, OCT, and automated perimetry were evaluated. Results: Disc area, cup area and cup/disc area ratio measured with HRT were significantly different between NTG and HTG (all p0.05). Mean deviation and corrected pattern standard deviation measured by automated perimetry was significantly correlated with mean and inferior RNFL thickness in both NTG and HTG (Pearson`s r, p<0.05). Mean RNFL thickness/disc area ratio was significantly larger in HTG than NTG (35.21±18.92 vs. 31.30±10.91, p=0.004). Conclusions: These findings suggest that optic disc and RNFL damage pattern in NTG may be different from those of HTGope

Ecological determinants of roe deer (Capreolus capreolus) spatial behavior and movement in limiting conditions

For the majority of large ungulates living in temperate regions winter is the limiting season, because of the combined effects of lack of resource availability and severity of climatic conditions. Those species that did not develop any particular morphological and physiological adaptation to cope with winter severity may adopt movement and space use tactics instead (like e.g. migration). Specifically, these space use patterns may emerge at different spatiotemporal scales to allow individuals to accede the resources they need and escape unfavourable conditions, thus determining both individual fate and population dynamics. A detailed understanding of the relationship between limiting factors in wintertime, and individual movement response, is remarkable to preserve and manage wildlife successfully, especially in the context of fast-occurring climate change that induces important alterations in landscape and resource distribution (e.g. changes of snow cover patterns). The comparison of movement tactics under different environmental scenarios, e.g. by means of large -scale analysis at the species distribution range, represents a valuable approach to work in that direction and to assess the effects of landscape alteration on individual movement. Roe deer (Capreolus capreolus) is an excellent model species to investigate these issues, because its distribution range covers most of Europe, thanks to its high ecological plasticity. For those populations that live in northern and mountain environments, winter is the limiting season because roe deer lack any morphological and physiological adaptations to cope with winter severity. In spite of the adoption of specific movement tactics such as partial migration from summer to winter ranges, roe deer may still face limiting conditions in some areas of the distribution range exposed to winter severity. Wildlife managers therefore have developed supplemental feeding programs to sustain roe deer (and other ungulate) populations. Regardless of the pervasiveness of this practice and the potential negative ecological consequences (such as for example the enhanced probability of disease transmission), if and how the interplay between distribution of supplemental feeding sites and winter severity may shape roe deer spatial ecology remains mostly unknown. During my PhD, I provided a contribution to investigate in this direction. First, I relied on the data stored and managed in the EURODEER database (www.eurodeer.org) to evaluate across a wide latitudinal and altitudinal gradient how individuals responded to the presence of these patchily distributed resources under different environmental conditions and supplemental feeding management. The comprehensiveness of large scale datasets such as EURODEER is counterbalanced by some limitations in terms of data resolution of some potentially meaningful environmental variables, such as snow cover. To overcome these limitations, I empirically collected accurate data on snow cover and snow sinking-depth to assess the combined effect of snow and of the distribution of feeding stations on winter resource selection in an Alpine population of roe deer. The investigation of the effect of feeding stations on individual space use tactics should go hand in hand with a proper assessment of the inter-individual relationships occurring at feeding stations, which in turn correspond to contacts btween animals. Measurements of contact rates is a relatively new ecological interest, and could be performed either by visual recording of observers, or by means of proximity loggers or, as alternative, using tr acking data that permit to infer spatial relationships from individual trajectories. The latter two approaches are more practical in terms of application, but both need to be carefully calibrated to avoid biased ecological inference derived from the obtained contact measurements. In this context, I performed a detailed analysis and modelling of the factors influencing the connectivity of recently introduced proximity loggers (WSN, Wireless Sensor Network). In parallel, I explored the potential applicability of SECONDO spatiotemporal database for the investigation of spatial relationships among individuals through the more widespread GPS tracking data. The large-scale comparative analyses I conducted along a wide latitudinal and altitudinal gradient showed that the use of feeding sites by roe deer is highly seasonal, and specifically associated to low temperatures and activation of the feeding stations, but not to snow cover. Moreover, I found some indications that winter use of feeding stations was negatively affected by the presence of competitors. Finally, I found a strong signal of the reduction of individual home range size in relation to feeding site use. Local assessment of roe deer winter resource selection partially supported these results: the main drivers of roe deer resource selection included the proximity to feeding stations (although to a lesser extent than expected) and, a more strong inverse relationship with snow sinkng depth. The main driver of roe deer habitat use was presence of forest canopy. The absence of any statistically significant effect of the index used for measuring snow at a large scale (MODIS) supported the importance of local measurements of snow to complement remotely-sensed data. The finding that the use of feeding stations leads individuals to concentrate their movements around these sites supports the hypothesis of high contact rate between individuals at feeding sites. i.e. as they would work as attractive points. The assessment of encounters is preliminary to the evaluation of such hypothesis. I have demonstrated Wireless Sensor Network proximity loggers as tools with high potentiality for assessment of encounters. At the same time, my work has strongly indicated the need to carefully calibrate these tools before applying them for any biological investigation, and provided practical guidelines on how to proceed, including how to model the error probability. Alternatively, I laid the first technical premises to assess encounters from the more widespread GPS tracking data, by means of high-performance queries within an appropriate spatiotemporal database. I conclude that roe deer use feeding stations, but only when winter conditions are particularly harsh (i.e. low temperature, abundant snow cover). In a context of climate change with an alteration of snow pattern distribution due to a general increase of temperatures, it would be essential to understand whether supplemental feeding management will still be a reasonable and effective tool to manage roe deer. More generally, it would be necessary to assess whether roe deer indeed need feeding stations for overwinter survival. This work clearly provides evidence that the distribution of feeding stations modifies roe deer spatial behaviour. A full understanding of the patterns of animal aggregation, derived from the correct measurement of contact rates, is thus fundamental to understand the consequences of supplemental feeding practices on animal welfare, and ecosystem consequences (e.g., disease transmission). Research in these directions would ultimately permit to understand the tradeoff between benefits and costs, both for wildlife, and as a human action, of supplemental feeding practices, thus helping wildlife managers to take the right decisions

Prevalence and risk factors for postnatal mental health problems in mothers of infants admitted to neonatal care: Analysis of two population-based surveys in England

Background Previous research suggests that mothers whose infants are admitted to neonatal units (NNU) experience higher rates of mental health problems compared to the general perinatal population. This study examined the prevalence and factors associated with postnatal depression, anxiety, post-traumatic stress (PTS), and comorbidity of these mental health problems for mothers of infants admitted to NNU, six months after childbirth. Methods This was a secondary analysis of two cross-sectional, population-based National Maternity Surveys in England in 2018 and 2020. Postnatal depression, anxiety, and PTS were assessed using standardised measures. Associations between sociodemographic, pregnancy- and birth-related factors and postnatal depression, anxiety, PTS, and comorbidity of these mental health problems were explored using modified Poisson regression and multinomial logistic regression. Results Eight thousand five hundred thirty-nine women were included in the analysis, of whom 935 were mothers of infants admitted to NNU. Prevalence of postnatal mental health problems among mothers of infants admitted to NNU was 23.7% (95%CI: 20.6–27.2) for depression, 16.0% (95%CI: 13.4–19.0) for anxiety, 14.6% (95%CI: 12.2–17.5) for PTS, 8.2% (95%CI: 6.5–10.3) for two comorbid mental health problems, and 7.5% (95%CI: 5.7–10.0) for three comorbid mental health problems six months after giving birth. These rates were consistently higher compared to mothers whose infants were not admitted to NNU (19.3% (95%CI: 18.3–20.4) for depression, 14.0% (95%CI: 13.1–15.0) for anxiety, 10.3% (95%CI: 9.5–11.1) for PTS, 8.5% (95%CI: 7.8–9.3) for two comorbid mental health problems, and 4.2% (95%CI: 3.6–4.8) for three comorbid mental health problems six months after giving birth. Among mothers of infants admitted to NNU (N = 935), the strongest risk factors for mental health problems were having a long-term mental health problem and antenatal anxiety, while social support and satisfaction with birth were protective. Conclusions Prevalence of postnatal mental health problems was higher in mothers of infants admitted to NNU, compared to mothers of infants not admitted to NNU six months after giving birth. Experiencing previous mental health problems increased the risk of postnatal depression, anxiety, and PTS whereas social support and satisfaction with birth were protective. The findings highlight the importance of routine and repeated mental health assessments and ongoing support for mothers of infants admitted to NNU

Identification of novel subgroup a variants with enhanced receptor binding and replicative capacity in primary isolates of anaemogenic strains of feline leukaemia virus

&lt;b&gt;BACKGROUND:&lt;/b&gt; The development of anaemia in feline leukaemia virus (FeLV)-infected cats is associated with the emergence of a novel viral subgroup, FeLV-C. FeLV-C arises from the subgroup that is transmitted, FeLV-A, through alterations in the amino acid sequence of the receptor binding domain (RBD) of the envelope glycoprotein that result in a shift in the receptor usage and the cell tropism of the virus. The factors that influence the transition from subgroup A to subgroup C remain unclear, one possibility is that a selective pressure in the host drives the acquisition of mutations in the RBD, creating A/C intermediates with enhanced abilities to interact with the FeLV-C receptor, FLVCR. In order to understand further the emergence of FeLV-C in the infected cat, we examined primary isolates of FeLV-C for evidence of FeLV-A variants that bore mutations consistent with a gradual evolution from FeLV-A to FeLV-C.&lt;p&gt;&lt;/p&gt; &lt;b&gt;RESULTS:&lt;/b&gt; Within each isolate of FeLV-C, we identified variants that were ostensibly subgroup A by nucleic acid sequence comparisons, but which bore mutations in the RBD. One such mutation, N91D, was present in multiple isolates and when engineered into a molecular clone of the prototypic FeLV-A (Glasgow-1), enhanced replication was noted in feline cells. Expression of the N91D Env on murine leukaemia virus (MLV) pseudotypes enhanced viral entry mediated by the FeLV-A receptor THTR1 while soluble FeLV-A Env bearing the N91D mutation bound more efficiently to mouse or guinea pig cells bearing the FeLV-A and -C receptors. Long-term in vitro culture of variants bearing the N91D substitution in the presence of anti-FeLV gp70 antibodies did not result in the emergence of FeLV-C variants, suggesting that additional selective pressures in the infected cat may drive the subsequent evolution from subgroup A to subgroup C.&lt;p&gt;&lt;/p&gt; &lt;b&gt;CONCLUSIONS:&lt;/b&gt; Our data support a model in which variants of FeLV-A, bearing subtle differences in the RBD of Env, may be predisposed towards enhanced replication in vivo and subsequent conversion to FeLV-C. The selection pressures in vivo that drive the emergence of FeLV-C in a proportion of infected cats remain to be established

Planning for a cohort study to investigate the impact and management of influenza in pregnancy in a future pandemic

Background: Evidence from the 2009 A/H1N1 influenza pandemic demonstrated that pregnant women are particularly vulnerable to infection and at an increased risk of death. Active data collection through the UK Obstetric Surveillance System (UKOSS) about women admitted to hospital during the 2009 A/H1N1 pandemic was used to inform ongoing clinical guidance regarding the use of antiviral treatment for pregnant women and demonstrated that, in addition to an increased risk of maternal morbidity, influenza infection in pregnancy is associated with poor perinatal outcomes, including an increased risk of stillbirth and preterm birth. This evidence influenced the decision to offer routine influenza immunisation to pregnant women. Even in a non-epidemic period, pregnant women continue to die from influenza. Objective: To establish, and then to put into hibernation, the study mechanisms needed to mount a rapid investigation of the impact of pandemic influenza in pregnancy in the event of a newly emerging pandemic strain. Design: A new UKOSS cohort study was designed, based on the 2009–10 study, and following consultation with the Pandemic Flu Planning Group at the Royal College of Obstetricians and Gynaecologists and the UKOSS Steering Committee, to identify potential previously unanswered questions. Setting: UK maternity units. Participants: All pregnant women admitted to hospital with influenza in a future pandemic. Main outcome measures: Management of pregnant women with influenza infection, intervention rates, treatment and pregnancy outcome for both the mother and fetus. Results: The study was designed and approved by the UKOSS Steering Committee and then placed into hibernation for activation in the event of an influenza pandemic. Conclusions: Pregnant women, as a result of their changed immunological status, appear to be particularly susceptible to infection, including from influenza. The existence of the UKOSS enabled us to rapidly mount a study of pregnant women who were hospitalised with 2009 A/H1N1 influenza. Minor modifications to incorporate previously unanswered questions and our previous study enabled us to design, and then put into hibernation, a new study ready to investigate the impact and management of influenza in pregnancy, which is poised for activation in the event of a newly emerging pandemic strain. This will enable real-time data to be available on which to base rapid changes in clinical management as the as-yet-unforeseen pandemic unfolds. In the event of an influenza pandemic the study will be available to be immediately activated following expedited regulatory approvals. Trial registration: Current Controlled Trials ISRCTN44137563. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Percepção na qualidade ambiental : praia do Lami, Porto Alegre, RS

Objective:To explore the long-term effects of women's childbearing patterns on their body mass index.Design:Cross-sectional analysis.Setting:Population- based study of UK women.Participants:740 628 postmenopausal participants in the Million Women Study who reported their height, weight, reproductive histories and other relevant factors.Main Outcome Measures:Standardized mean BMI (kg m -2) in groups defined by their parity and breastfeeding history.Results:Women were aged 57.5 (s.d. 4) years on average, and had a mean BMI of 26.2 kg m -2 (s.d. 5); 88% were parous, with 2.1 (s.d. 1.2) children on average. The standardised mean BMI increased progressively with the number of births from 25.6 kg m -2 (95% confidence interval (CI): 25.5-25.6) in nulliparous women up to 27.2 kg m -2 (CI: 27.2-27.3) for women with four or more births, a difference of 1.7 kg m -2 (CI: 1.6-1.7). Among the parous women 70% had ever breastfed and their average total duration of breastfeeding was 7.7 (s.d. 8.8) months. At every parity level the standardised mean BMI was significantly lower among women who had breastfed than those who had not, decreasing by 0.22 kg m -2 (CI: 0.21-0.22) for every 6 months of breastfeeding, that is, women's mean BMI was 1% lower for every 6 months that they had breastfed. These associations were highly statistically significant (P<0.0001) and independent of the effects of socioeconomic group, region of residence, smoking and physical activity.Conclusions:Childbearing patterns have a persistent effect on adiposity in this population. The reduction in BMI associated with just 6 months breastfeeding in UK women could importantly reduce their risk of obesity-related disease as they age. © 2013 Macmillan Publishers Limited

Measuring Coverage in MNCH:A Validation Study Linking Population Survey Derived Coverage to Maternal, Newborn, and Child Health Care Records in Rural China

Accurate data on coverage of key maternal, newborn, and child health (MNCH) interventions are crucial for monitoring progress toward the Millennium Development Goals 4 and 5. Coverage estimates are primarily obtained from routine population surveys through self-reporting, the validity of which is not well understood. We aimed to examine the validity of the coverage of selected MNCH interventions in Gongcheng County, China.We conducted a validation study by comparing women's self-reported coverage of MNCH interventions relating to antenatal and postnatal care, mode of delivery, and child vaccinations in a community survey with their paper- and electronic-based health care records, treating the health care records as the reference standard. Of 936 women recruited, 914 (97.6%) completed the survey. Results show that self-reported coverage of these interventions had moderate to high sensitivity (0.57 [95% confidence interval (CI): 0.50-0.63] to 0.99 [95% CI: 0.98-1.00]) and low to high specificity (0 to 0.83 [95% CI: 0.80-0.86]). Despite varying overall validity, with the area under the receiver operating characteristic curve (AUC) ranging between 0.49 [95% CI: 0.39-0.57] and 0.90 [95% CI: 0.88-0.92], bias in the coverage estimates at the population level was small to moderate, with the test to actual positive (TAP) ratio ranging between 0.8 and 1.5 for 24 of the 28 indicators examined. Our ability to accurately estimate validity was affected by several caveats associated with the reference standard. Caution should be exercised when generalizing the results to other settings.The overall validity of self-reported coverage was moderate across selected MNCH indicators. However, at the population level, self-reported coverage appears to have small to moderate degree of bias. Accuracy of the coverage was particularly high for indicators with high recorded coverage or low recorded coverage but high specificity. The study provides insights into the accuracy of self-reports based on a population survey in low- and middle-income countries. Similar studies applying an improved reference standard are warranted in the future

A comparison of physicians and medical assistants in interpreting verbal autopsy interviews for allocating cause of neonatal death in Matlab, Bangladesh: can medical assistants be considered an alternative to physicians?

Objective. This study assessed the agreement between medical physicians in their interpretation of verbal autopsy (VA) interview data for identifying causes of neonatal deaths in rural Bangladesh. Methods. The study was carried out in Matlab, a rural sub-district in eastern Bangladesh. Trained persons conducted the VA interview with the mother or another family member at the home of the deceased. Three physicians and a medical assistant independently reviewed the VA interviews to assign causes of death using the International Classification of Diseases - Tenth Revision (ICD-10) codes. A physician assigned cause was decided when at least two physicians agreed on a cause of death. Cause-specific mortality fraction (CSMF), kappa (k) statistic, sensitivity, specificity, and positive predictive values were applied to compare agreement between the reviewers.Results. Of the 365 neonatal deaths reviewed, agreement on a direct cause of death was reached by at least two physicians in 339 (93%) of cases. Physician and medical assistant reviews of causes of death demonstrated the following levels of diagnostic agreement for the main causes of deaths: for birth asphyxia the sensitivity was 84%, specificity 93%, and kappa 0.77. For prematurity/low birth weight, the sensitivity, specificity, and kappa statistics were, respectively, 53%, 96%, and 0.55, for sepsis/meningitis they were 48%, 98%, and 0.53, and for pneumonia they were 75%, 94%, and 0.51. Conclusion. This study revealed a moderate to strong agreement between physician- assigned and medical assistant- assigned major causes of neonatal death. A well-trained medical assistant could be considered an alternative for assigning major causes of neonatal deaths in rural Bangladesh and in similar settings where physicians are scarce and their time costs more. A validation study with medically confirmed diagnosis will improve the performance of VA for assigning cause of neonatal death