Real-Time Genomic Epidemiological Evaluation of Human Campylobacter Isolates by Use of Whole-Genome Multilocus Sequence Typing

Sequence-based typing is essential for understanding the epidemiology of Campylobacter infections, a major worldwide cause of bacterial gastroenteritis. We demonstrate the practical and rapid exploitation of whole-genome sequencing to provide routine definitive characterization of Campylobacter jejuni and Campylobacter coli for clinical and public health purposes. Short-read data from 384 Campylobacter clinical isolates collected over 4 months in Oxford, United Kingdom, were assembled de novo. Contigs were deposited at the pubMLST.org/campylobacter website and automatically annotated for 1,667 loci. Typing and phylogenetic information was extracted and comparative analyses were performed for various subsets of loci, up to the level of the whole genome, using the Genome Comparator and Neighbor-net algorithms. The assembled sequences (for 379 isolates) were diverse and resembled collections from previous studies of human campylobacteriosis. Small subsets of very closely related isolates originated mainly from repeated sampling from the same patients and, in one case, likely laboratory contamination. Much of the within-patient variation occurred in phase-variable genes. Clinically and epidemiologically informative data can be extracted from whole-genome sequence data in real time with straightforward, publicly available tools. These analyses are highly scalable, are transparent, do not require closely related genome reference sequences, and provide improved resolution (i) among Campylobacter clonal complexes and (ii) between very closely related isolates. Additionally, these analyses rapidly differentiated unrelated isolates, allowing the detection of single-strain clusters. The approach is widely applicable to analyses of human bacterial pathogens in real time in clinical laboratories, with little specialist training required.     

Mauling of the “Celtic Tiger”: Clinical characteristics and outcome of first-episode depression secondary to the economic recession in Ireland

Background

There is a dearth of studies describing clinical characteristics and outcome of patients who present with mood disorders related to economic recession.

Aims

To describe a cohort of patients admitted with first-episode depression related to the Irish economic recession and compare this cohort with all other first-episode depressives admitted during the same time period (2009–2010).

Methods

A cohort of 137 patients admitted with first-episode depression to an independent university teaching hospital was prospectively identified and followed up from admission over 2 years (mean follow-up 430 days, s.d. 176 days). The cohort was divided into “Celtic Tiger” (patients with first-episode depression secondary to the economic recession) and non-Celtic Tiger control patients (other first-episode depressed patients). Both groups were compared in terms of clinical characteristics at baseline and outcome over follow-up.

Results

The number of admissions due to first depressive episodes were higher in recession years 2009/10 than in pre-recession years 2008/9. Celtic Tiger patients were predominantly male and more severely depressed with more marked suicidal ideation (χ², p<0.001) than control patients. They were more likely to recover (χ², p=0.013), less likely to recur (χ², p<0.001) and had faster time to recovery (log rank, p<0.001) and slower time to full recurrence (log rank, p=0.001). The Celtic Tiger patients spent more time asymptomatic and less time at full and subthreshold depression levels over follow-up.

Limitations

Study setting of centre specializing in affective disorders treatment, retrospective nature of follow-up after initial prospective interview and lack of patient follow-up interview.

Conclusion

The study describes a subgroup of patients with severe depression associated with economic recession with likely high suicide risk but very favourable outcome.     

Book review of Human Growth: Assessment and Interpretation. By Alex F. Roche and Shumei S. Sun. (Cambridge University Press,Cambridge, 2003). [pp. 311]. ISBN: 0 521 78245 7. US$95, £53.50.

Background: In many parts of the developing world, modernization has resulted in an increase in the prevalence of overweight and obesity and a subsequent rise in nutrition-related, non-communicable diseases such as cardiovascular disease and Type 2 diabetes.

Aim: The study examined the impact of socio-economic and lifestyle changes associated with modernization on the body size and shape of Balinese women.

Subjects and methods: Anthropometric data including weight, height, body mass index (BMI) and seven skinfolds were collected from 564 Balinese women, aged between 15 and 45 years. The relationship between the degree of ‘modernization’ (using such parameters as household wealth and education level) and body size and shape was analysed using multiple regression analysis, as was the effect of age, family size and breast-feeding.

Results: Using the WHO (WHO ) categories of BMI, 14% of Balinese women displayed Chronic Energy Deficiency (BMI<18.5?kg?m^?2), 7% were overweight (BMI?=?25.0–29.9?kg?m^?2) and less than 1% were obese (BMI?≥?30.0?kg?m^?2). Household wealth (p<0.0001) and education level (p<0.05) were significantly associated with fatness, while breast-feeding (p<0.05) was significantly associated with leanness. Fat distribution was largely independent of biological and socio-economic variables.

Conclusions: The trend toward increasing fatness associated with greater household wealth and higher education has important health implications for Balinese women as they continue their rapid transition from subsistence agriculture towards a more ‘western’ lifestyle.

Résumé. Arrière plan: Dans de nombreuses régions du globe, à la faveur du développement et de la modernisation, est apparue une prévalence du surpoids et de l’obésité ainsi qu’un accroissement corollaire de maladies non infectieuses telles que les maladies cardiovasculaires et le diabète de type 2.

But: L’étude examine l’impact des changements socioéconomiques et de style de vie associés à la modernisation, sur le format et la forme du corps des femmes balinaises.

Sujets et méthodes: Des données anthropométriques comprenant le poids, la stature, l’indice de masse corporelle (IMC) et sept plis cutanés, ont été collectées sur 564 femmes balinaises âgées de 15 à 45 ans. La relation entre le degré de ‘modernisation’ (au moyen de paramètres tels que l’aisance du foyer et le niveau éducatif) et la forme et le format corporel a été analysée, ainsi que les effets de l’âge, de la dimension de la famille et de l’allaitement maternel, au moyen de régressions multiples.

Résultats: Par rapport aux catégories d’IMC de l’OMS (1995), 14% des femmes balinaises présentent une déficience chronique d’énergie (IMC<18,5?kg?m^?2), 7% ont du surpoids (IMC?=?25,0–29,9?kg?m^?2) et moins de 1% sont obèses (IMC≥30,0?kg?m^?2). L’aisance du foyer (p<0,0001) et le niveau éducatif (p<0,05) sont associés significativement à l’adiposité tandis que l’allaitement maternel l’est avec la minceur. La distribution de l’adiposité est largement indépendante des variables biologiques et socioéconomiques.

Conclusion: La tendance en direction d’un accroissement de l’adiposité en association avec meilleure aisance domestique et meilleure éducation présente des implications importantes pour la santé des femmes balinaises, dans la mesure où elles poursuivent une rapide transition d’une agriculture de subsistance à un mode de vie plus ‘occidental’.

Zusammenfassung. Hintergrund: In vielen Entwicklungsländern hat die Modernisierung zu einem Anstieg der Prävalenz von Übergewicht und Adipositas geführt und in der Folge zu einem Anstieg ernährungsabhängiger nicht-übertragbarer Erkrankungen wie kardiovaskulärer Krankheiten und Typ2 Diabetes.

Ziel: Die Studie untersuchte die Bedeutung der mit der Modernisierung einhergehenden, sozio-ökonomischen Veränderungen und der Veränderungen des Lebensstils auf Körpermaße und Körperproportionen Balinesischer Frauen.

Probanden und Methoden: Anthropometrische Daten einschließlich Gewicht, Höhe, Körpermasse-Index (body mass index, BMI) und sieben Hautfettfalten wurden bei 564 Balinesischen Frauen im Alter zwischen 15 und 45 Jahren erhoben. Die Beziehung zwischen dem Grad der ‘Modernisierung’ (unter Verwendung von Begriffen wie verfügbares Haushaltseinkommen und Schulbildung) und Körpermaßen und Körperproportionen wurde mittels multipler Regressionsanalysen hinsichtlich der Effekte von Alter, Familiengröße und Stillen untersucht.

Ergebnisse: Unter Verwendung der WHO-Kategorien () für BMI zeigten 14% der Balinesischen Frauen Zeichen eines chronischen kalorischen Defizits (BMI??2), 7% waren übergewichtig (BMI?=?25,0—29,9?kg?m^?2) und weniger als 1% waren adipös (BMI?≥?30,0?kg?m^?2). Verfügbares Haushaltseinkommen (p<0,0001) und Schulbildung (p<0,05) waren signifikant mit übergewicht, Stillen jedoch (p<0,05) signifikant mit Magerkeit korreliert. Die Fettverteilung war überwiegend unabhängig von den biologischen und sozio-ökonomischen Variablen.

Zusammenfassung: Der Trend zu zunehmendem Übergewicht, der mit größerem verfügbaren Haushaltseinkommen und besserer Schulbildung assoziiert ist, hat große gesundheitliche Bedeutung für Balinesischer Frauen, solange ihr rasanter Übergang von einer landwirtschaftlichen Subsistenzkultur zu einem mehr ‘westlichen’ Lebensstil anhält.

Resumen. Antecedentes: En muchos lugares del mundo en vías de desarrollo, la modernización ha producido un incremento de la prevalencia del sobrepeso y la obesidad así como del riesgo subsecuente de sufrir enfermedades no transmisibles relacionadas con la nutrición, como la enfermedad cardiovascular y la diabetes tipo 2.

Objetivo: El estudio examinó el impacto de los cambios socioeconómicos y del estilo de vida asociados con la modernización sobre el tamaño y la forma corporal de las mujeres balinesas.

Sujetos y Métodos: Se recogieron datos antropométricos que incluían el peso, la estatura y el índice de masa corporal (IMC) de 564 mujeres de Bali, con edades comprendidas entre los 15 y 45 años. La relación entre el grado de ‘modernización’ (utilizando parámetros como la salud familiar y el nivel de educación) y el tamaño y la forma del cuerpo se analizó mediante un análisis de regresión múltiple, que consideraba el efecto de la edad, el tamaño familiar y el amamantamiento.

Resultados: Según las categorías de la WHO () para el IMC, el 14% de las mujeres balinesas mostraron una Deficiencia Energética Crónica (IMC<18,5?kg?m^?2), el 7% presentaba sobrepeso (IMC?=?25,0–29,9?kg?m^?2) y menos del 1% eran obesas (IMC?≥?30,0?kg?m^?2). La salud familiar (p<0,0001) y el nivel de estudios (p<0,05) estaban significativamente asociados con la adiposidad (exceso de peso), mientras que el amamantamiento (p<0,05) estaba significativamente asociado con la delgadez. La distribución de grasa era muy independiente de las variables biológicas y socioeconómicas.

Conclusiones: La tendencia hacia un incremento de la adiposidad cuanto mejor es la salud familiar y mayor el nivel de educación tiene importantes implicaciones sanitarias para las mujeres balinesas, a medida que éstas continúan su rápida transición desde la agricultura de subsistencia hacia un estilo de vida más ‘occidentalizado’.     

Correction to: Quality use of diagnostic imaging in trauma,and the impact on emergency medical practice—a retrospective clinical audit

Emergency Radiology - A Correction to this paper has been published: https://doi.org/10.1007/s10140-021-01926-1     

Type D Personality is Not Associated with Coronary Heart Disease Risk in a North American Sample of Retirement-aged Adults

Background

Type D personality is associated with recurrent coronary heart disease (CHD) risk but there is limited and inconsistent evidence regarding incident risk among persons free of clinical CHD.

Purpose

We examined the association between Type D personality and coronary heart disease (CHD) risk in apparently healthy adults. We also explored the association of these traits with waist circumference, body mass index (BMI), and inhibited physician consultation behavior.

Methods

Cross-sectional study of North American retirement-aged residents (N?=?303). The primary outcome variable was a modified 10-year absolute CHD risk score from the Framingham Heart Study. Secondary outcomes included adiposity and a 5-item measure of patient/provider interaction inhibition. We regressed CHD risk on negative affect (NA), social inhibition (SI), and the NAxSI interaction (i.e., the Type D personality) and repeated these analyses for adiposity and for patient/provider interaction inhibition. We also contrasted CHD risk across Type D and non-Type D categories.

Results

None of the personality variables were associated with CHD risk for the whole sample (regression coefficients from ?0.11 to .10, Ps?>?0.29) or in gender-specific analyses. For adiposity, NA was positively associated and SI was negatively associated with BMI in women (Ps?<?0.05), but there were no other personality associations. Patient/provider interaction inhibition was associated with SI (P?<?0.001) but not NA or the NAxSI interaction (P?=?0.42). The contrast between Type D and non-Type D personality revealed no differences in CHD risk (P?=?0.93).

Conclusions

Neither Type D nor its constituent NA and SI traits were associated with absolute incident CHD risk in retirement-aged adults free of reported CHD. Optimal analytic practices and attention to patient/provider interaction behavior will improve our understanding of the association between Type D personality traits and health.     

What Is the Learning Curve for the Anterior Approach for Total Hip Arthroplasty?

Background

There are many factors that may affect the learning curve for total hip arthroplasty (THA) and surgical approach is one of these. There has been renewed interest in the direct anterior approach for THA with variable outcomes reported, but few studies have documented a surgeon’s individual learning curve when using this approach.

Questions/purposes

(1) What was the revision rate for all surgeons adopting the anterior approach for placement of a particular implant? (2) What was the revision rate for surgeons who performed > 100 cases in this fashion? (3) Is there a minimum number of cases required to complete a learning curve for this procedure?

Methods

The Australian Orthopaedic Association National Joint Replacement Registry prospectively collects data on all primary and revision joint arthroplasty surgery. We analyzed all conventional THAs performed up to December 31, 2013, with a primary diagnosis of osteoarthritis using a specific implant combination and secondarily those associated with surgeons performing more than 100 procedures. Ninety-five percent of these procedures were performed through the direct anterior approach. Procedures using this combination were ordered from earliest (first procedure date) to latest (last procedure date) for each individual surgeon. Using the order number for each surgeon, five operation groups were defined: one to 15 operations, 16 to 30 operations, 31 to 50 operations, 51 to 100 operations, and > 100 operations. The primary outcome measure was time to first revision using Kaplan-Meier estimates of survivorship.

Results

Sixty-eight surgeons performed 5499 THAs using the specified implant combination. The cumulative percent revision at 4 years for all 68 surgeons was 3% (95% confidence interval [CI], 2.5–3.8). For surgeons who had performed over 100 operations, the cumulative revision rate was 3% (95% CI, 2.0–3.5). It was not until surgeons had performed over 50 operations that there was no difference in the cumulative percent revision compared with over 100 operations. The cumulative percent revision for surgeons performing 51 to 100 operations at 4 years was 3% (95% CI, 1.5–5.4) and over 100 operations 2% (95% CI, 1.2–2.7; hazard ratio, 1.40 [95% CI, 0.7–2.7]; p = 0.33).

Conclusions

There is a learning curve for the anterior approach for THA even when using a prosthesis combination specifically marketed for that approach. We found that 50 or more procedures need to be performed by a surgeon before the rate of revision is no different from performing 100 or more procedures. Surgeons should be aware of this initial higher rate of revision when deciding which approach delivers the best outcome for their patients.