Antenatal depression and drug use among deaf and hard-of-hearing birthing parents: results from a U.S. National Survey

PURPOSE

This study aimed to investigate antenatal depression and drug use among deaf and hard-of-hearing (DHH) birthing parents who use American Sign Language (ASL), spoken English, or bilingually both ASL and English.

METHODS

DHH participants in the United States responded to the Survey on Pregnancy Experiences of Deaf and Hard-of-Hearing Women. Respondents self-reported their antenatal depression diagnoses and drug use (i.e., pain relievers, cannabis, or illicit drugs) during their last pregnancy. Poisson regression models were used to estimate prevalence ratios, adjusting for age, race/ethnicity, education, marital status, and parity.

RESULTS

The average age of respondents (n = 587) was 35 years. Respondents were predominantly non-Hispanic white (80%), college educated (60%), and married (74%). Relative to DHH English-speakers, DHH ASL-users had lower prevalence of reporting antenatal depression diagnosis (aPR = 0.40, 95% CI: 0.23 to 0.72). DHH people who reported antenatal depression diagnosis had higher prevalence of reporting antenatal drug use (PR = 2.34, 95% CI: 1.65 to 3.33). There were no significant associations between preferred language and antenatal drug use.

CONCLUSIONS

DHH ASL-users are less likely to report receiving an antenatal depression diagnosis compared to DHH English-speakers. Given well-documented patient-provider communication barriers among DHH ASL-users, it is unclear if the lower prevalence observed in this study is the result of inadequate or inaccessible screening during pregnancy. Future work should consider universal use of linguistically appropriate screening tools for DHH birthing parents in both clinical and research settings.

Prevalence of opisthorchiid and other endoparasitic infections among cats and dogs in Novosibirsk oblast (Western Siberia, Russia)

To determine the current reservoir status and prevalence of Opisthorchis felineus infection in opisthorchiosis-endemic areas, feces samples were collected from 103 cats and 101 dogs admitted to shelters or discount sterilization centers from various districts of Novosibirsk city and from villages and towns along the Ob River (Novosibirsk Oblast). The feces samples were evaluated using two methods simultaneously: the formalin-ether sedimentation assay and a modified flotation assay. The prevalence of opisthorchiid infection was higher among cats (12.6%; 95% confidence interval 6.9-20.6%) than among dogs (4.0%; 95% confidence interval 1.1-9.8%). Overall prevalence of endoparasites among cats was 42.7% (five helminthic and four protozoan species) and among dogs 51.5% (eight helminthic and five protozoan species). Among the parasites found in the dogs, the prevalence of Sarcocystis sp. was the highest (16.8%), and in cats, the highest prevalence was shown by Giardia sp. and Toxocara cati (14.6% for each species). These results confirm the considerable contribution of stray cats and dogs to the maintenance of opisthorchiid eggs in the environment; these data should be taken into account for the development of effective control and education programs.

Is inpatient rehabilitation a predictor of a lower incidence of persistent knee pain 3-months following total knee replacement? A retrospective, observational study

Background

Moderate to severe levels of persistent knee pain have been estimated to affect up to 25% of people 3-months or more after a total knee replacement. It is unknown whether the type of rehabilitation pathway is associated with persistent high pain after surgery. Using a prospectively followed Australian cohort who underwent total knee replacement for knee osteoarthritis, this study aimed to i) report the incidence of high-intensity knee pain (defined as a score ≤ 15 on the Oxford Knee Score pain subscale) across time and ii) identify whether referral to inpatient rehabilitation was one of the predictors of persistent pain at 3-months post-surgery.

Methods

A retrospective analysis of a large prospective study was conducted using the Oxford Knee Score pain subscale to determine if participants had high pain at 3-months, 12-months and 36-months post-surgery. Relative risks for high pain at 3-, 12- and 36-months between the type of rehabilitation pathway were determined using Poisson multivariable regression with robust standard errors. The same technique was also employed to determine potential predictors, including rehabilitation pathway, of high pain at 3 months.

Results

The incidence of high pain in all participants was 73% pre-surgery and 10, 5 and 6% at 3-, 12- and 36-months respectively following knee replacement. There was a significant interaction between time and rehabilitation pathway, suggesting that the effect of the rehabilitation pathway varied across time. The incidence of high pain at 3-months did not significantly differ between those who attended inpatient rehabilitation (11.6%) and those discharged directly home (9.5%). Multivariable Poisson regression analysis identified the pre-surgical presence of high pain, co-morbid low back pain or other lower limb problem, younger age and having a major complication within 3-months following surgery as significant predictors of persistent pain whilst discharge to inpatient rehabilitation was not.

Conclusion

A small but clinically significant minority of people continued to have high pain levels at 3-, 12- and 36-months following a primary total knee replacement for osteoarthritis. Participation in an inpatient rehabilitation program does not appear to be an important predictor of ongoing knee pain.

Trial registration

The data were collected in the Evidence-based Processes and Outcomes of Care (EPOC) study, ClinicalTrials.gov Identifier: NCT01899443

Epidemiological characteristics and genetic diversity of Bartonella species in rodents from southeastern China

Rodents are the primary hosts of Bartonella species and carry more than 22 Bartonella species. However, the information on epidemiological characteristics and genetic diversity of Bartonella species in rodents in southeastern China is limited. From 2015 to 2020, 1,137 rodents were captured. Bartonella-positive DNA was detected in 14.9% (169/1,137) of rodents by PCR for both the ssrA and gltA genes. A highest Bartonella prevalence was detected in Apodemus agrarius (33.5%) and lowest in B. indica (1.8%). The probability of Bartonella infection in summer (20.1%) was higher than in spring (14.6%; p = .011, OR = 1.756). Sequencing and phylogenetic analysis revealed that nine known Bartonella species were identified in rodents, including B. tribocorum, B. grahamii, B. rattimassiliensis, B. queenslandensis, B. elizabethae, B. phoceensis, B. coopersplainsensis, B. japonica and B. rochalimae. In our study, Bartonella species exhibited a strong association with their hosts. Zoonotic B. tribocorum, B. grahamii, B. elizabethae and B. rochalimae were found in synanthropic rodent species in southeastern China, which pose a potential threat to the public health. To prevent the spread of zoonotic Bartonella species to humans, preventive and control measures should be implemented, and more research is needed to confirm the pathogen's association with human disease.

Poverty, sanitation, and Leptospira transmission pathways in residents from four Brazilian slums

Residents of urban slums suffer from a high burden of zoonotic diseases due to individual, socioeconomic, and environmental factors. We conducted a cross-sectional sero-survey in four urban slums in Salvador, Brazil, to characterize how poverty and sanitation contribute to the transmission of rat-borne leptospirosis. Sero-prevalence in the 1,318 participants ranged between 10.0 and 13.3%. We found that contact with environmental sources of contamination, rather than presence of rat reservoirs, is what leads to higher risk for residents living in areas with inadequate sanitation. Further, poorer residents may be exposed away from the household, and ongoing governmental interventions were not associated with lower transmission risk. Residents at higher risk were aware of their vulnerability, and their efforts improved the physical environment near their household, but did not reduce their infection chances. This study highlights the importance of understanding the socioeconomic and environmental determinants of risk, which ought to guide intervention efforts.

Globally, more than 1 billion residents live in urban slums, where inadequate sanitation increases the spread of pathogens and their animal hosts. Leptospirosis is a globally distributed bacterial disease, and in urban areas the bacteria is spread by brown rats. Humans become infected upon exposure to water or soil/mud that was contaminated with the urine of infected rats. In four urban slums in the city of Salvador, Brazil, we used a range of individual, socioeconomic, and environmental variables to understand how they influence to one another and define o leptospirosis exposure in residents. Poverty and sanitation influenced the degree to which residents were exposed to sewer water and mud. Further, we found that while residents tried to improve the physical environment near their household, living in an area with poor sanitation mean that their infection risk remained high. This work highlight the importance of socioeconomic and environmental factors in determining disease risk, and suggests that governmental interventions should focus on improving sanitation changes in the poorest parts of the community.

High prevalence and diversity of Bartonella in small mammals from the biodiverse Western Ghats

Bartonella species are recognized globally as emerging zoonotic pathogens. Small mammals such as rodents and shrews are implicated as major natural reservoirs for these microbial agents. Nevertheless, in several tropical countries, like India, the diversity of Bartonella in small mammals remain unexplored and limited information exists on the natural transmission cycles (reservoirs and vectors) of these bacteria. Using a multi-locus sequencing approach, we investigated the prevalence, haplotype diversity, and phylogenetic affinities of Bartonella in small mammals and their associated mites in a mixed-use landscape in the biodiverse Western Ghats in southern India. We sampled 141 individual small mammals belonging to eight species. Bartonella was detected in five of the eight species, including three previously unknown hosts. We observed high interspecies variability of Bartonella prevalence in the host community. However, the overall prevalence (52.5%) and haplotype diversity (0.9) was high for the individuals tested. Of the seven lineages of Bartonella identified in our samples, five lineages were phylogenetically related to putative zoonotic species–B. tribocorum, B. queenslandensis, and B. elizabethae. Haplotypes identified from mites were identical to those identified from their host species. This indicates that these Bartonella species may be zoonotic, but further work is necessary to confirm whether these are pathogenic and pose a threat to humans. Taken together, these results emphasize the presence of hitherto unexplored diversity of Bartonella in wild and synanthropic small mammals in mixed-use landscapes. The study also highlights the necessity to assess the risk of spillover to humans and other incidental hosts.

Zoonotic bacterial infections cause both economic and health burdens to humans, especially in developing countries. Bartonella is a diverse group with several species that are infectious to humans. There is limited knowledge of Bartonella diversity and subsequent risk for spillover in several tropical countries, including India. This study, set in a biodiversity hotspot with high human density, reveals a high prevalence and diversity of Bartonella in the most common, and synanthropic small mammals. Several lineages identified are phylogenetically related to zoonotic species known to cause infections in humans. We suggest that there is unexplored diversity of Bartonella in small mammals that reside in human-modified landscapes in India, demonstrating an urgent need for further investigation. By identifying the natural reservoirs of pathogens, their ecology, and their relationship and proximity to humans, we will be able to proactively survey for these under-detected bacterial infections and minimize the burden.

Common Medical and Statistical Problems: The Dilemma of the Sample Size Calculation for Sensitivity and Specificity Estimation

Sample size calculation in biomedical practice is typically based on the problematic Wald method for a binomial proportion, with potentially dangerous consequences. This work highlights the need of incorporating the concept of conditional probability in sample size determination to avoid reduced sample sizes that lead to inadequate confidence intervals. Therefore, new definitions are proposed for coverage probability and expected length of confidence intervals for conditional probabilities, like sensitivity and specificity. The new definitions were used to assess seven confidence interval estimation methods. In order to determine the sample size, two procedures—an optimal one, based on the new definitions, and an approximation—were developed for each estimation method. Our findings confirm the similarity of the approximated sample sizes to the optimal ones. R code is provided to disseminate these methodological advances and translate them into biomedical practice.

Distribution, Prevalence, and Maximum Intensity of the Ectoparasitic Copepod Salmincola cf. Edwardsii in Brook Trout in Wisconsin Streams

Since the late 19th century, the ectoparasitic copepod Salmincola cf. edwardsii has been observed infecting brook trout ( Salvelinus fontinalis) in Wisconsin streams. A perceived increase in the incidence of S. cf. edwardsii infection across the state and the observation of an S. edwardsii epizootic leading to declines in brook trout recruitment in Ash Creek, Wisconsin, have raised concerns about the extent to which S. edwardsii threaten other populations of brook trout in Wisconsin streams. In 2013-2017, brook trout were inspected in 282 streams across the state to determine the distribution, prevalence, and maximum intensity of infection of adult female copepods whose morphology was consistent with S. edwardsii. Salmincola cf. edwardsii were present in 79% of streams and absent from 21%. Prevalence of infection ranged from 0.4 to 100% where the parasite was present. Maximum intensity of infection was low (1-5 S. cf. edwardsii) in 31% of streams, moderate (6-14) in 35% of the streams, and high (≥15) in 34% of the streams. Maximum intensity was high and prevalence exceeded 90% of brook trout in 9 streams, suggesting epizootics as observed in Ash Creek are uncommon. Our statewide distributional data are critical to understanding the scope of S. cf. edwardsii infection of brook trout in Wisconsin's recreational fisheries and will provide a baseline for ongoing and future investigations of S. cf. edwardsii-brook trout dynamics.

Brachylaimiasis: Brachylaima spp. (Digenea: Brachylaimidae) Metacercariae Parasitizing the Edible Snail Cornu aspersum (Helicidae) in Spanish Public Marketplaces and Health-Associated Risk Factors

The edible land snail Cornu aspersum (Pulmonata: Stylommatophora) acts as a second intermediate host in the terrestrial life cycle of Brachylaima spp. trematodes, harboring unencysted metacercariae in its kidney. The ingestion of undercooked infected snails by humans may allow metacercariae to potentially develop to adult stage in the intestine, causing brachylaimiasis, as already seen in Australia. The prevalence and dynamics of C. aspersum parasitization by Brachylaima spp. metacercariae in specimens intended for human consumption in Spanish marketplaces were studied. In total, 3,710 C. aspersum specimens were analyzed over 5 yr, which were obtained from public marketplaces in the Spanish cities of Barcelona, Bilbao, Madrid, Tudela, Valencia, and Zaragoza. The overall prevalence was 41.97% (95% CI: 40.38-45.56%). The Tudela marketplace had the highest values for both the seasonal prevalence and abundance in all studies during autumn (93.57% and 3.09, respectively). This market also gave the highest individual metacercarial burden recorded, 212 metacercariae in a single specimen. Overall, the highest prevalence of Brachylaima spp. occurred in autumn (58.65%) and the lowest in winter (22.64%). There was a seasonal effect on prevalence, which increased from summer to autumn and then decreased in winter. In total, 96 experimental Brachylaima adults were obtained from the metacercariae parasitizing the analyzed snails. These were identified through morphometric tools (principal component analysis) as Brachylaima mascomai (56 in Barcelona, 1 in Bilbao, 7 in Tudela, and 3 in Valencia), and Brachylaima llobregatensis (17 in Barcelona, 8 in Bilbao, 1 in Valencia, and 3 in Zaragoza). Logistic regression modeling, conducted to predict the probability of purchasing parasitized snails using city and season as predictors showed a correct prediction overall of 79.0%, with a significant (p = 0.001) risk effect in the Barcelona-autumn interaction (2.551-38.442), a significant (p = 0.049) protection effect in the Tudela-spring interaction (0.076-0.997), a significant (p < 0.001) risk effect in the Tudela-autumn interaction (4.330-78.584), and a significant (p = 0.014) protection effect in the Valencia-spring interaction (0.033-0.687). The high overall prevalence of Brachylaima spp. metacercariae should be a matter of concern for public health authorities, mainly in countries where C. aspersum is consumed.

Temporal Community Structure in Two Gregarines (Rotundula gammari and Heliospora longissima) Co-Infecting the Amphipod Gammarus fasciatus

This study surveyed gregarine parasites that infect the amphipod, Gammarus fasciatus , to investigate temporal dynamics in infracommunity structure. We sampled a population of hosts for 2 yr from the north branch of the Raritan River in New Jersey. These hosts were infected with 2 direct life cycle gregarine parasites, Rotundula gammari and Heliospora longissima. Infections were separated temporally, with the prevalence of R. gammari peaking within the amphipod population in the fall (prevalence = 78% year 1 and 97% year 2) and H. longissima peaking in early spring (prevalence = 41% year 1 and 52% year 2). Increases in host population density did not significantly correlate with the abundance of these 2 parasites. However, H. longissima abundance was positively correlated with host body weight while R. gammari showed no significant relationship. The mean body mass of amphipods infected with H. longissima was 20.7 ± 1. 2 mg, and with R. gammari 8.1 ± 0.2 mg, which suggests a sized-based infection pattern. Mixed species infections were infrequent with an overall prevalence of 4.6%. When both gregarine species co-infected the same host, the R. gammari but not the H. longissima infrapopulation size was significantly lower when compared to single-species infections, suggesting asymmetric interactions. We conclude that the observed temporal patterns of infection by the 2 parasites are driven by a seasonal change in host demographics and size-dependent infections. We argue that specificity for host developmental stages may have arisen as a mechanism to avoid overlap between these gregarine species.

The risk of carriage of Salmonella spp. and Listeria monocytogenes in food animals in dynamic populations

Salmonella spp. and Listeria monocytogenes are foodborne pathogens of global importance. We assessed their risks and associated factors in a highly dynamic population of animals. Animal and environmental samples were collected from dairy cattle, sheep, camel and chickens at either the farms or the abattoirs. The pathogens were detected using a combination of bacterial enrichment culture and real‐time polymerase chain reaction (PCR). Data on putative risk factors were collect and analysed for their significance of association with these pathogens.

Salmonella spp. were detected at higher proportions in sheep faeces and sheep carcasses in comparison to cattle faeces (odds ratio = 2.4 and 2.2, respectively). This pathogen was less common in milk or carcasses samples from cattle or chickens. Sheep and camel carcass samples were highly contaminated with Salmonella spp. Faecal samples from cattle had the most diverse serovars of Salmonella enterica including S. Newport, S. Haifa, S. Kedougou, S. Kentucky, S. Mbandaka and S. Goettingen. Exotic serovars in sheep included S. Eastbourne, S. Chester and S. Kottnus. Serovars that were shed in camel faeces included S. Newport, S. Bovismorbificans and S. Infantis. In all sampled populations, detection of Salmonella spp. was more likely during warmer months than cold months. Listeria monocytogenes was not common in the targeted populations and was detected at a rate of 2.4%, mainly from sheep carcasses. The study highlights the role of food animals as reservoirs of pathogens across boundaries since all feed are imported in that population from different parts of the world.

Variation in Parasite Communities in Spottail Shiners (Notropis hudsonius) Linked with Precipitation

The Richelieu River, Quebec, is a highly-regulated waterway subject to numerous anthropogenic influences from municipal effluents and agricultural activities. Parasite communities in 234 spottail shiners (Notropis hudsonius) were examined from 4 localities in late spring 2003 and 2004. Component species richness varied between 15 and 18 species in 2003 but declined to 9 to 13 in 2004, while total parasite abundance was consistently lower in 2003. Parasite component community similarity among localities could not be directly linked to available upstream water quality measurements or anthropogenic activity and was best explained by precipitation. Total precipitation in May 2003 was approximately 40% more than in May 2004, presumably altering patterns of runoff, river flow rates, and water quality. This study suggests that fish parasite species composition and richness in the Richelieu River are influenced by environmental parameters which in turn ultimately are driven by a combination of climatic conditions and anthropogenic activities in the watershed.

Praziquantel efficacy against Brachylaima sp. metacercariae (Trematoda: Brachylaimidae) parasitizing the edible landsnail Cornu aspersum and its HPLC-MS/MS residue determination

Cornu aspersum is a terrestrial edible snail, often parasitized by Brachylaima (Trematoda) metacercariae. Ingestion of undercooked snails by humans allows metacercariae to develop to adult in the intestine causing brachylaimiasis (expected mortality rate 5-10%). The cosmopolitan character of the trematode and of its vector, enhanced in a future climate change scenario, and the absence of adequate sanitary controls of the snails in marketplaces clearly increase the risk of human brachylaimiasis. The treatment of farmed snails with praziquatel (PZQ) would be a tool to control this food-borne disease. The objectives of this study were: to report the prevalence of Brachylaima metacercariae parasitizing C. aspersum in marketplaces, to assess the efficacy and tolerance of PZQ in C. aspersum and to develop an HPLC-MS/MS analytical method to quantify PZQ residue in the edible snail (the acceptable daily intake of PZQ is 0.17 mg/kg bw in humans). Prevalence of parasitization of C. aspersum by Brachylaima metacercariae in public marketplaces reached the 80%. PZQ was orally administered to snails, mixed with the usual snail food. In dose determination assays three doses were individually tested (10 days): 1.2 mg PZQ/snail, 1.8 mg PZQ/snail (efficacy 97.3%, p < 0.001) and 2.4 mg PZQ/snail (efficacy 98.7%, p < 0.001). In dose confirmation tests (n = 200) the 2.4 mg PZQ/snail dose was group tested (10 snails/box, 7 days): 2 g of PZQ supplemented snail food were disposed daily in the treatment group boxes and 2 g of snail food (placebo) in the control boxes (efficacy 94.6%, p < 0.001; prevalence dropped from 68.7% in control group to 10.1% in treatment group, p < 0.001). Received dose was 220.2 mg PZQ/kg snail with shell. In the analytical method, linearity, lower limit of quantification (0.05 μg/ml), selectivity, carry over, accuracy, precision, dilution integrity, matrix effect and stability were tested. Sixty snails were treated (11 mg PZQ/g snail food) and analyzed. PZQ was detected and quantified (0.093 mg PZQ/g snail). PZQ treatment of C. aspersum is effective, well tolerated by the snail, affordable and easy to reproduce in snail farms.

The Bass Parasites of Oneida Lake, 80 Years Later

A survey of largemouth (Micropterus salmoides) and smallmouth bass (Micropterus dolomieu) parasite communities in Oneida Lake, New York, was conducted in the summer of 2012 and compared to an earlier survey conducted by Van Cleave and Mueller during the summers of 1929 to 1931. The component helminth communities between surveys were 31% similar in composition for largemouth and 28% similar for smallmouth bass. Between species, the component helminth communities were considerably more similar in the present survey (71%) than in the survey conducted by Van Cleave and Mueller (47%). Seven species reported by Van Cleave and Mueller were present in this survey and 21 species are new records for the bass of Oneida Lake. Van Cleave and Mueller did not report prevalence values for several taxa (Monogenea, Copepoda, Myxozoa, and a Trichodina sp.) that were important for separation of parasite infracommunities in species space for both bass species. These parasites represented 28% of all species found in the current survey and may be ecologically important. Several species of parasites exhibited differences in prevalence between surveys. Two species (Rhipidocotyle papillosa and Crepidostomum cornutum) were absent from this survey but were reported as common in the 1929-1931 survey and almost certainly represent extirpations that coincide with the loss of their native bivalve hosts from Oneida Lake. Other differences in the parasite communities may also be explained by the ecological disturbances in Oneida Lake over the past 81 yr. The changes in bass parasite communities between surveys emphasize the importance of recognizing the historical nature of parasite communities, especially in ecosystems with a history of large-scale changes. Most importantly our findings suggest that, similar to trends observed in free-living freshwater biotic communities, anthropogenic ecosystem disturbances may homogenize fish parasite communities.