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Infection with the parasitic nematode Strongyloides stercoralis is characteristic for tropical and subtropical regions of the world, but autochthonous cases have been reported in European countries as well. Here we present the first nation-wide survey of S. stercoralis seroprevalence in Croatian individuals presenting with eosinophilia, and evaluate the fraction of positive microscopy rates in stool specimens of seropositive individuals. In our sample of 1407 patients tested between 2018 and 2021, the overall prevalence of strongyloidiasis was 9.31%, with significantly higher rates in those older than 60 years of age (P = 0.005). Of those, one-quarter (25.95%) were also positive following microscopy examination of faeces after using the merthiolate–iodine–formaldehyde concentration method. Our findings reinforce the notion of endemic strongyloidiasis transmission in Croatia, particularly in older individuals, and highlight the need to consider the presence of S. stercoralis in patients with eosinophilia.
Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad.
Comprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18–64 with previously untreated psychotic disorders residing in each catchment area (May 2018–April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years).
We found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68–3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51–0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93–1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area.
This study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.
Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking.
To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups.
A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment.
Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72–1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61–10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65–10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm.
Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.
Existing approaches to psychosis prediction capture only a small minority of future cases. Recent research shows that specialist child and adolescent mental health services (CAMHS) offer a (previously unrecognised) high-risk and high-capacity approach for psychosis early identification, prediction and, ultimately, prevention.
Tail and ear biting lesions have a negative effect both on the animal welfare status of pigs (Sus scrofus) and the economical revenue of the pig farm. Tail biting behaviour is an unpredictable, abnormal behaviour that is thought to have a multifactorial origin. On-farm factors influencing tail biting have been described, but the real triggers are poorly understood. Much of the research into tail biting has been done on a small scale within a well-controlled environment and small sample sizes. This well-controlled environment is not always representative of the contemporary commercial conditions. Therefore, an observational epidemiological approach at farm level was adopted to gain a better insight into the factors influencing the occurrence of tail and ear biting lesions. Tail and ear biting lesions were observed at pen level three times a year on sixty farms across Belgium. A questionnaire was conducted to build a multifactorial model indicating different risk factors concerning the lesions scored. The temperature and the number of feeding places per animal in the nursery, the percentage of floor space covered with slats in the farrowing unit, the feed type in the growing unit and the overall hygiene policy were the most important indicators for the appearance of tail and ear biting lesions during fattening. The leave-one-out cross validation of the model demonstrated an intraclass correlation coefficient of 0.55 between the predicted model outcomes and the observed data. This epidemiological study provides important potential risk factors in relation to the incidence of tail and ear biting lesions. However, experimental and/or longitudinal studies have to confirm that the correlations found in this work are causal factors.
Many breeds of companion animal have inherited disorders that may impair quality of life (QoL) to the extent that it is unkind to keep them alive. If we struggle to discern when this point is reached, why do we breed compromised, short-lived animals in the first place? If we struggle to judge when environmental conditions cause an unacceptable QoL, why not breed appropriately for modern environments? In breeding pedigree dogs, five major problems arise: (1) some breed standards and selection practices run counter to dog welfare; (2) insufficient selection pressure seems to be exerted on some traits that would improve animal well-being and produce dogs better suited to modern environments; (3) the incidence of certain inherited defects in some breeds is unacceptably high; (4) the dearth of registered animals of certain breeds in particular countries makes it extremely difficult for breeders to avoid mating close relatives; and (5) there may be financial disincentives for veterinarians to reduce the incidence of inherited diseases. Before we can judge when behavioural or morphological changes caused by selective breeding result in an unacceptable QoL, we have to know which are prevalent. This paper reviews progress in two Australian schemes to monitor trends in the prevalence of inherited disorders in dogs and to promote behavioural phenotypes likely to cope with contemporary domestic environments.
Since 2018, the International Task Force on Benzodiazepines (ITFB), a group of academic psychiatrists and academic psychologists, has advocated that clinical guidelines should change to promote benzodiazepines from second- to first-line treatment for anxiety disorders, accept their use as maintenance treatment for anxiety conditions (in particular, panic disorder) and increase their use in gastrointestinal disorders. There is merit in much of what the ITFB argues, but in this article I analyse four major claims it has made in opinion editorials that I believe are not fully supported by the available evidence.
The impact of individual symptoms reported post-COVID-19 on subjective well-being (SWB) is unknown. We described associations between SWB and selected reported symptoms following SARS-CoV-2 infection. We analysed reported symptoms and subjective well being from 2295 participants (of which 576 reporting previous infection) in an ongoing longitudinal cohort study taking place in Israel. We estimated changes in SWB associated with reported selected symptoms at three follow-up time points (3–6, 6–12 and 12–18 months post infection) among participants reporting previous SARS-CoV-2 infection, adjusted for key demographic variables, using linear regression. Our results suggest that the biggest and most sustained changes in SWB stems from non-specific symptoms (fatigue −7.7 percentage points (pp), confusion/ lack of concentration −10.7 pp, and sleep disorders −11.5pp, P < 0.005), whereas the effect of system-specific symptoms, such as musculoskeletal symptoms (weakness in muscles and muscle pain) on SWB, are less profound and more transient. Taking a similar approach for other symptoms and following individuals over time to describe trends in SWB changes attributable to specific symptoms will help understand the post-acute phase of COVID-19 and how it should be defined and better managed. Post-acute COVID19 symptoms were associated with a significant decrease in subjective well being up to 18 months after initial infection
Cancer has been associated with lower risk of dementia, although methodological issues raise concerns about the validity of this association. We recruited 31,080 men aged 65–85 years who were free of cancer and dementia, and followed them for up to 22 years. We used health record linkage to identify incident cases of cancer and dementia, and split time span to investigate this association. 18,693 (60.1%) and 6897 (22.2%) participants developed cancer and dementia during follow-up. The hazard ratio (HR) of dementia associated with cancer was 1.13 (95% CI = 1.07, 1.20) and dropped to 0.85 (95% CI = 0.80, 0.91) when 449 participants who developed dementia within 2 years were excluded. The diagnosis of cancer seems to facilitate the early detection of dementia cases. Older participants who survive cancer for 2 or more years have lower risk of receiving the diagnosis of dementia over time. The factors that mediate this association remain unclear.
The validity of an ANI-based welfare index for cattle, the A-Index, was evaluated using Test Theory methods described for quality of life assessments in human medicine. Content validity was considered during the modification of the Index for Finnish beef production. In total, 43 items evaluating locomotion abilities, lying area, social environment, management, feeding, and health of animals over six months up to slaughter were formed. Index scorings were performed on 237 farms. A most consistent partial A-Index was constructed based on qualitative item analyses. A positive relationship was established between the full A-Index and daily carcase gain. In addition, a preliminary negative relationship was established between the partial A-Index, body fat and mortality. Based on our observations, methods used for quality of life indices in human beings would appear suitable for animal welfare assessment. Practicability and well-defined methodology are the main advantages of Test Theory approach.
The effect that breed standards and selective breeding practices have on the welfare of pedigree dogs has recently come under scrutiny from both the general public and scientific community. Recent research has suggested that breeding for particular aesthetic traits, such as tightly curled tails, highly domed skulls and short muzzles predisposes dogs with these traits to certain inherited defects, such as spina bifida, syringomyelia and brachycephalic airway obstruction syndrome, respectively. Further to this, there is a very large number of inherited diseases that are not related to breed standards, which are thought to be prevalent, partly as a consequence of inbreeding and restricted breeding pools. Inherited diseases, whether linked to conformation or not, have varying impact on the individuals affected by them, and affect varying proportions of the pedigree dog population. Some diseases affect few breeds but are highly prevalent in predisposed breeds. Other diseases affect many breeds, but have low prevalence within each breed. In this paper, we discuss the use of risk analysis and severity diagrams as means of mapping the overall problem of inherited disorders in pedigree dogs and, more specifically, the welfare impact of specific diseases in particular breeds.
In-transit losses (ITL) in fattening pigs refers to mortality occurring after having left the farm but prior to stunning at the abattoir. The purpose of this observational study was to identify the associations between environmental and truck temperatures, distances travelled, feed withdrawal, farm, transport company and abattoir and in-transit losses of fattening pigs marketed in Ontario, Canada from 2001 to 2004. A prospective study of 104 trips was conducted to determine temperatures inside the truck and identify the factors associated with this. In 2001, ITL was 0.017%, with 75% of producers losing < 5 pigs annually. In-transit losses increased between distances travelled of 590 to 720 km and decreased at distances greater than 980 km. The Pig Comfort Index, a combination of temperature and humidity, was used to identify thresholds of environmental conditions above which in-transit losses increased. The farm at which the pig was raised explained more variation of ITL (25%) than transport company (8%) or abattoir (16%). The within-farm ITL in 2003 had a positive association with those in 2001 and 2002. Withdrawing food prior to transport may decrease ITL on some farms. The temperature in truck compartments holding pigs increased by 0.99°C as the environmental temperature increased by 1°C and by 0.1°C as the relative humidity increased by 1%. Truck temperature decreased 0.06°C for each increase in driving speed of 10 km h−1 and increased by 7°C with an increase in pig density from one to 2.6 pigs per m2.
Science forms a vital part of animal welfare assessment. However, many animal welfare issues are more influenced by public perception and political pressure than they are by science. The discipline of epidemiology has had an important role to play in examining the effects that management, environment and infrastructure have on animal-based measures of welfare. Standard multifactorial analyses have been used to investigate the effects of these various inputs on outcomes such as lameness. Such research has thereby established estimates of the probability of occurrence of these adverse welfare outcomes (AWOs) and given exposure to particular management inputs (welfare challenges). Welfare science has established various measures of the consequences of challenges to welfare. In this paper, a method is proposed for comparing the likely impact of different welfare challenges, incorporating both the probability of AWOs resulting from that welfare challenge, and their impacts or consequences if they do, using risk assessment principles. The rationale of this framework is explained. Its scope lies within a science-based risk assessment framework. This method does not provide objective measures or score of welfare without some context of comparison and does not provide new welfare measures but only provides a framework enabling objective comparison. Possible applications of this method include comparing the effects of specific management inputs, assigning priority to welfare challenges in order to inform allocation of resources for addressing those challenges, and comparisons of the lifetime welfare effects of management inputs or systems. The use of risk assessment methods in the animal welfare field can facilitate objective comparisons of situations that are currently assessed with some level of subjectivity. This methodology will require significant validation to determine its most productive use. The risk assessment approach could have a productive role in advancing quantitative assessment in animal welfare science.
Good animal welfare is crucial for the success of circuses and zoos. Epidemiological studies of animal welfare that investigate associations between animal-based measures (ABMs) and resource- and management-based measures are needed. However, due to the relatively low numbers of animals within each species kept at individual facilities, such investigations can be difficult to carry out. In this paper, we report the analysis of a multi-facility epidemiological study using data from all regulatory inspections of circus and zoo animals in Sweden for 2010 to 2014. Information from 42 inspections of 38 circuses, and 318 inspections of 179 zoos was analysed. For ABMs assessed during routine inspections of circuses (n = 14) and zoos (n = 61), 9.1 and 14.3% did not comply with requirements for general care of hooves/claws and coat, 10.0 and 8.6% for body condition, and 0 and 1.7% for animal cleanliness, respectively. In addition, the zoo checklist assessed whether animals were kept in appropriate groups, finding non-compliance in 17.0% of inspections. The most frequent non-compliant resource- and management-based measures at routine inspections of circuses were for space (41.7%) and exercise requirements (38.5%). For zoos, 29.4% did not comply with space followed by 28.8% for enrichment requirements. In multivariable logistic regression analyses, zoos that had inadequate or unsafe housing and space design, inadequate bedding, or failed to meet nutritional requirements, were more likely to be non-compliant with at least one ABM. The checklists should be improved to better assess welfare status by including more ABMs; benchmarking of risks and trends over time is also recommended.
This research project was carried out by the Swedish Dairy Association as part of the development of a ‘Scheme for Animal Welfare’. As a first step, on-farm, animal-based measurements on calves, young stock and cows in 55 randomly selected herds were performed. Nine animal-based measurements formed the basis for a classification of welfare at the herd level: cleanliness and body condition in calves, cows and young stock, in combination with lameness, injuries/inflammations and rising behaviour which were recorded for cows only. The threshold (gold standard) for being a case herd with poor welfare, was a score lying among the worst 10% on two or more of the nine welfare measurements. Thirteen of the 55 herds were cases fitting this criterion. As a second step, 65 potential welfare indicators from seven different focus areas in a pre-collected data register were identified by expert opinion. In the final step, the extent to which suggested potential welfare indicators predicted farms’ risk of having poor welfare according to the definition was assessed. The final set of welfare indicators, taken from the national dairy database, included two fertility measures and calf mortality, and it correctly classified 77% of the herds, with a sensitivity of 0.62. The inclusion of cow and young stock mortality led to it correctly classifying 76% of the herds with a sensitivity of 0.77. We propose that this approach could be useful in helping to allocate advisory services to farms at risk of poor welfare.
Undesirable behaviours (UBs) are common in dogs and can jeopardise animal and human health, leading to dog abandonment and euthanasia. Dogs exhibiting UBs may have compromised welfare from underlying emotional motivations for the behaviour (eg anxiety) or from the methods used by owners to resolve the problem (eg aversive techniques). The objective of this study was to estimate proportional mortality due to UBs and risk factors for death due to UBs, including death from road traffic accidents, in dogs under three years of age attending primary-care veterinary practices in England from 2009-2014. Cases were identified by searching de-identified electronic patient records from primary-care veterinary practices participating in the VetCompass Programme. The findings highlight that dogs under three years of age are at a proportionately high risk of death due to UBs (33.7%) compared with other specific causes of death (eg gastrointestinal issues: 14.5%). Male dogs had 1.40x the odds of death from UB compared with females. The proportional mortality from UB for male dogs where information on the cause of death was available was 0.41. Neutered dogs had 1.94x the odds of death due to a UB compared with entire dogs. Aggression was the most prevalent UB overall. Veterinarians had recommended referral in 10.3% of cases where dogs died due to exhibiting a UB and had dispensed nutraceutical, pheromone or pharmacological treatment to 3.0% of the UB cases that died. This study shows that undesirable behaviours require better preventive measures and treatment, through further research and education of veterinarians, other professionals within the dog industry and owners.
Several established models in human and veterinary medicine exist to evaluate an individual health or disease status. Many of these seem unsuitable for further epidemiological research aimed at discovering underlying influential factors. As a case example for score development and choice, the present study analyses different approaches to scoring the foot health of Asian elephants (Elephas maximus) living in European facilities. Sum scores with varying degree of detail, and without or with a weighting method, were compared using descriptive statistics, ie kurtosis, skewness, Shannon entropy, total redundancy, their maximum and their actual ranges. With increasing score complexity, a higher level of differentiation was reached. In parallel, the distribution of score frequencies in the population shifted systematically: with the least complex scoring model the pattern indicated a severely unhealthy population with an opposite skew to a hypothetically healthy population, whereas the most complex scoring model indicated a mildly affected population with a skew corresponding to that expected for a healthy population. We propose the latter, in the form of the Particularised Severity Score (ParSev), which accounts for every nail and pad individually and weights the sub-scores by squaring, as the most relevant score for further investigations, either in assessing changes within an elephant population over time, or correlating foot health in epidemiological studies to potentially influencing factors. Our results emphasise the relevance of choosing appropriate scoring models for welfare-associated evaluations, due to implications for the applicability as well as the perceived welfare status of the test population.
The apicomplexan parasite Cyclospora cayetanensis causes seasonal foodborne outbreaks of the gastrointestinal illness cyclosporiasis. Prior to the coronavirus disease-2019 pandemic, annually reported cases were increasing in the USA, leading the US Centers for Disease Control and Prevention to develop a genotyping tool to complement cyclosporiasis outbreak investigations. Thousands of US isolates and 1 from China (strain CHN_HEN01) were genotyped by Illumina amplicon sequencing, revealing 2 lineages (A and B). The allelic composition of isolates was examined at each locus. Two nuclear loci (CDS3 and 360i2) distinguished lineages A and B. CDS3 had 2 major alleles: 1 almost exclusive to lineage A and the other to lineage B. Six 360i2 alleles were observed – 2 exclusive to lineage A (alleles A1 and A2), 2 to lineage B (B1 and B2) and 1 (B4) was exclusive to CHN_HEN01 which shared allele B3 with lineage B. Examination of heterozygous genotypes revealed that mixtures of A- and B-type 360i2 alleles occurred rarely, suggesting a lack of gene flow between lineages. Phylogenetic analysis of loci from whole-genome shotgun sequences, mitochondrial and apicoplast genomes, revealed that CHN_HEN01 represents a distinct lineage (C). Retrospective examination of epidemiologic data revealed associations between lineage and the geographical distribution of US infections plus strong temporal associations. Given the multiple lines of evidence for speciation within human-infecting Cyclospora, we provide an updated taxonomic description of C. cayetanensis, and describe 2 novel species as aetiological agents of human cyclosporiasis: Cyclospora ashfordi sp. nov. and Cyclospora henanensis sp. nov. (Apicomplexa: Eimeriidae).
Previous research has suggested that some women are at increased risk of postpartum depression (PPD) because of an extra sensitivity to fluctuating hormones before and after parturition. This may particularly apply to women with endocrine disease, characterised by a less than optimal capability to self-regulate the hormonal feedback system.
To investigate if women with endocrine disease history are at increased risk of developing PPD.
Based on information from Danish national registers, this nationwide cohort study included 888 989 deliveries (1995–2018). Endocrine disease history was defined as thyroid disease, pre-pregnancy diabetes, polycystic ovary syndrome and/or previous gestational diabetes within 10 years before pregnancy start. PPD was defined as use of antidepressants and/or hospital contact for depression within 6 months after childbirth.
Among 888 989 deliveries, 4.1% had a history of endocrine disease and 0.5% had a PPD episode. Overall, women with an endocrine disease history had a 42% (risk ratio 1.42, 95% CI 1.24–1.62) higher risk of PPD when compared with women with no endocrine disease. However, we also found the reverse association, whereby women with a PPD history had a 50% (hazard ratio 1.5, 95% CI 1.4–1.6) higher risk of endocrine disease when compared with women with no PPD history.
Women with endocrine disease history had a 40% higher risk of PPD compared with women with no endocrine disease. More attention should be given to pregnant women with endocrine disease history to increase awareness of early signs of PPD. The bi-directionality of the association points to a common underlying factor.
Although age-standardized stroke occurrence has been decreasing, the absolute number of stroke events globally, and in Canada, is increasing. Stroke surveillance is necessary for health services planning, informing research design, and public health messaging. We used administrative data to estimate the number of stroke events resulting in hospital or emergency department presentation across Canada in the 2017–18 fiscal year.
Hospitalization data were obtained from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database and the Ministry of Health and Social Services in Quebec. Emergency department data were obtained from the CIHI National Ambulatory Care Reporting System (Alberta and Ontario). Stroke events were identified using ICD-10 coding. Data were linked into episodes of care to account for readmissions and interfacility transfers. Projections for emergency department visits for provinces/territories outside of Alberta and Ontario were generated based upon age and sex-standardized estimates from Alberta and Ontario.
In the 2017–18 fiscal year, there were 108,707 stroke events resulting in hospital or emergency department presentation across the country. This was made up of 54,357 events resulting in hospital admission and 54,350 events resulting in only emergency department presentation. The events resulting in only emergency department presentation consisted of 25,941 events observed in Alberta and Ontario and a projection of 28,409 events across the rest of the country.
We estimate a stroke event resulting in hospital or emergency department presentation occurs every 5 minutes in Canada.