Knowledge, attitudes, and behaviors regarding tick-borne disease prevention in Lyme disease-endemic areas of the Upper Midwest, United States

Lyme disease and other tick-borne diseases are a major public health threat in the Upper Midwestern United States, including Michigan, Minnesota, and Wisconsin. To prevent tick bites and tick-borne diseases, public health officials commonly recommend personal protective measures and property management techniques. Adoption of tick-borne disease prevention behaviors and practices by individuals are, however, highly variable. We aimed to characterize current tick-borne disease knowledge, attitudes, and prevention behaviors (KAB) practiced by the public in these states, as well as their willingness to use specific tick control methods. We conducted a population-based survey in summer 2019 in 48 high-risk counties (those having a five-year average (2013-2017) Lyme disease incidence of ≥ 10 cases per 100,000 persons per year), in Michigan, Minnesota, and Wisconsin. A total of 2713 surveys were analyzed; survey weights were used to account for household selection probability and post-stratified to match county-level joint age and sex population distributions in population-level inference. An estimated 98% of the population had heard of Lyme disease, with most perceiving it as very or extremely serious (91%); however, only an estimated 25% perceived tick-borne diseases as very or extremely common in their community. Among those who spent time in places with ticks from April through October, an estimated 68% check themselves thoroughly for ticks most of the time or always and 43% use bug repellent on skin or clothing most of the time or always. An estimated 13% of the population had ever treated their property with a pesticide to kill ticks, and 3% had ever used devices that apply pesticide to rodents to kill ticks on their property. Willingness to practice tick bite prevention behaviors, however, was estimated to be much higher; with 82% being willing to perform tick checks at least once a day, and more than 60% willing to use bug repellent, tick control products on pets, or to bathe within two hours of being outdoors. We found that residents would likely be willing to support a county-wide tick control program to reduce the risk of tick-borne disease in their community (81%) or to apply tick control products to their property to reduce the risk of tick-borne disease in their household (79%). Tick checks were more likely to be practiced among participants who perceived tick-borne diseases to be highly prevalent in their community, if they or a household member had been previously diagnosed with a tick-borne disease?, or if they perceived tick exposure to be likely around their home, cabin, or vacation home. In addition, property-based tick control methods were associated with perceived risk of encountering ticks around the home, cabin, or vacation home. Participants who had seen information from state health departments were also more likely to practice preventive measures. The most common reported barriers to using any of these methods were forgetfulness, safety concerns, and lack of awareness. Our survey findings shed light on how residents from these Upper Midwest states may adopt tick control and tick bite prevention measures and how public health outreach may be most effective for this population.

Remote ischemic conditioning improves outcome independent of anesthetic effects following shockwave-induced traumatic brain injury

Traumatic brain injury due to primary blast exposure is a major cause of ongoing neurological and psychological impairment in soldiers and civilians. Animal and human evidence suggests that low-level blast exposure is capable of inducing white matter injury and behavioural deficits. There are currently no effective therapies to treat the underlying suspected pathophysiology of low-level primary blast or concussion. Remote ischemic conditioning (RIC) has been shown to have cardiac, renal and neuro-protective effects in response to brief cycles of ischemia. Here we examined the effects of RIC in two models of blast injury. We used a model of low-level primary blast in rats to evaluate the effects of RIC neurofilament expression. We subsequently used a model of traumatic brain injury in adult zebrafish using pulsed high intensity focused ultrasound (pHIFU) to evaluate the effects of RIC on behavioural outcome and apoptosis in a post-traumatic setting. In blast exposed rats, RIC pretreatment modulated NF200 expression suggesting an innate biological buffering effect. In zebrafish, behavioural deficits and apoptosis due to pHIFU-induced brain injury were reduced following administration of serum derived from RIC rats. The results in the zebrafish model demonstrate the humoral effects of RIC independent of anesthetic effects that were observed in the rat model of injury. Our results indicate that RIC is effective in improving outcome following modeled brain trauma in pre- and post-injury paradigms. The results suggest a potential role for innate biological systems in the protection against pathophysiological processes associated with impairment following shockwave induced trauma.

Light therapy for non-seasonal depression: systematic review and meta-analysis

BACKGROUND

Light therapy is a known treatment for patients with seasonal affective disorder. However, the efficacy of light therapy in treating patients with non-seasonal depression remains inconclusive.

AIMS

To provide the current state of evidence for efficacy of light therapy in non-seasonal depressive disorders.

METHOD

Systematic review of randomised controlled trials (RCTs) was conducted by searching MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL from their inception to September 2015. Study selection, data abstraction and risk of bias assessment were independently conducted in duplicate. Meta-analyses were performed to provide a summary statistic for the included RCTs. The reporting of this systematic review follows the PRISMA guidelines.

RESULTS

A meta-analysis including 881 participants from 20 RCTs demonstrated a beneficial effect of light therapy in non-seasonal depression (standardised mean difference in depression score -0.41 (95% CI -0.64 to -0.18)). This estimate was associated with significant heterogeneity (I2=60%, P=0.0003) that was not sufficiently explained by subgroup analyses. There was also high risk of bias in the included trials limiting the study interpretation.

CONCLUSIONS

The overall quality of evidence is poor due to high risk of bias and inconsistency. However, considering that light therapy has minimal side-effects and our meta-analysis demonstrated that a significant proportion of patients achieved a clinically significant response, light therapy may be effective for patients with non-seasonal depression and can be a helpful additional therapeutic intervention for depression.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Flea-Associated Bacterial Communities across an Environmental Transect in a Plague-Endemic Region of Uganda

The vast majority of human plague cases currently occur in sub-Saharan Africa. The primary route of transmission of Yersinia pestis, the causative agent of plague, is via flea bites. Non-pathogenic flea-associated bacteria may interact with Y. pestis within fleas and it is important to understand what factors govern flea-associated bacterial assemblages. Six species of fleas were collected from nine rodent species from ten Ugandan villages between October 2010 and March 2011. A total of 660,345 16S rRNA gene DNA sequences were used to characterize bacterial communities of 332 individual fleas. The DNA sequences were binned into 421 Operational Taxonomic Units (OTUs) based on 97% sequence similarity. We used beta diversity metrics to assess the effects of flea species, flea sex, rodent host species, site (i.e. village), collection date, elevation, mean annual precipitation, average monthly precipitation, and average monthly temperature on bacterial community structure. Flea species had the greatest effect on bacterial community structure with each flea species harboring unique bacterial lineages. The site (i.e. village), rodent host, flea sex, elevation, precipitation, and temperature also significantly affected bacterial community composition. Some bacterial lineages were widespread among flea species (e.g. Bartonella spp. and Wolbachia spp.), but each flea species also harbored unique bacterial lineages. Some of these lineages are not closely related to known bacterial diversity and likely represent newly discovered lineages of insect symbionts. Our finding that flea species has the greatest effect on bacterial community composition may help future investigations between Yersinia pestis and non-pathogenic flea-associated bacteria. Characterizing bacterial communities of fleas during a plague epizootic event in the future would be helpful.

Association between BDNF levels and suicidal behaviour: a systematic review protocol

BACKGROUND

Suicide is a worldwide public health concern that claims close to 1 million lives each year. Suicidal behaviour is a significant risk factor for completed suicide and is much more prevalent than completed suicide. Many internal and external factors contribute to the risk of suicidal behaviour. Recent research has focused on biological markers in suicide risk, including brain-derived neurotrophic factor (BDNF). BDNF is a protein involved in the growth, function, and maintenance of the nervous system. It has been implicated in psychiatric disorders and suicide. While some evidence suggests that reduced levels of BDNF are associated with suicide, the precise relationship has yet to be determined. The aim of this study is to review the literature examining the relationship between levels of BDNF and suicidal behaviour.

METHODS

A predefined search strategy will be implemented to search the following electronic databases: PubMed/MEDLINE, Excerpta Medica Database (EMBASE), PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) from inception. The articles will be screened by two independent authors (RE and SP) using predetermined inclusion and exclusion criteria. Discrepancies will be resolved by consensus, or by a third author (ZS) in cases of disagreement. The primary outcome will be the association between levels of BDNF and suicidal behaviour. A meta-analysis will be conducted if appropriate. Quality of evidence and risk of bias will be evaluated.

DISCUSSION

The findings of this review will assist in identifying and treating individuals at increased risk of suicide.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015015871 .

Association between body mass index and suicidal behaviors: a systematic review protocol

BACKGROUND

Suicide is among the leading causes of death worldwide. Suicide attempts and suicidal ideation are more common than completed suicide and are associated with psychological distress. These behaviors are considered risk factors of completed suicide. Considering the psychosocial stigma and medical comorbidities associated with obesity, an accumulating body of studies have investigated body mass index (BMI) as a potential risk factor of suicide. However, several cohort studies have demonstrated an inverse relationship between BMI and completed suicide, suggesting a protective effect of increasing BMI against completed suicide. The association between BMI and attempted suicide is more equivocal, with several studies reporting both positive and negative relationships between BMI and attempted suicide. The primary objective of this study is to systematically review the literature to determine the association between BMI and suicidal behavior (including completed suicide, attempted suicide, suicidal ideation) in an adult population (18 years and older). The secondary objective is to explore whether sex, age, and the method used in suicide modify the relationship between BMI and suicidal behavior.

METHODS/DESIGN

An electronic search will be conducted using PubMed/MEDLINE, PsycINFO, CINAHL, and EMBASE using a predefined search strategy; databases will be searched from their inception. Two authors (SP and RE) will independently screen articles using predefined inclusion and exclusion criteria and will extract pertinent data using a pilot tested extraction form. At all levels of screening, discrepancies between the two authors will be resolved by consensus, and in the case of disagreement, by consulting a third author (ZS). The primary outcomes include the association between BMI and completed suicide, attempted suicide, and suicidal ideation. If appropriate, a meta-analysis will be conducted. Risk of bias and quality of evidence will be assessed.

DISCUSSION

The results of this systematic review will inform health care professionals and researchers about whether BMI has a significant role in suicidal behavior and psychological well-being.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014014739 .

Detection of eastern equine encephalitis virus antibodies in moose (Alces americana), Maine, 2010

Moose sera were collected from harvested animals during the 2010 hunting season in Maine. Of the 145 serum samples screened by plaque reduction neutralization test (PRNT), 16 (11%) had antibodies to eastern equine encephalitis virus (EEEV). Positive samples were collected from Aroostook County (n=13), Somerset County (n=2), and Piscataquis County (n=1) in northern and central Maine. Preliminary mosquito surveillance revealed the presence of enzootic and bridge vectors mosquitoes, including Culiseta (Climacura) melanura (Coquillett), Aedes (Aedimorphus) vexans (Meigen), and Coquillettidia (Coquillettidia) perturbans (Walker). Select mosquito species were tested by RT-PCR for the presence of EEEV. None were positive. This is the first report of EEEV in moose from Maine.

Neuritis ossificans of the tibial, common peroneal and lateral sural cutaneous nerves

We describe a 23-year-old woman with neuritis ossificans involving the tibial, common peroneal and lateral sural nerves. She presented with chronic debilitating posterior knee pain. An MRI scan showed masses in these nerves, biopsy of which revealed a histological diagnosis of neuritis ossificans. Treatment with OxyContin and Neurotin for two years resulted in resolution of symptoms. Follow-up MRI demonstrated a resolution of two of the three masses. There was a persistent area of ossification without associated oedema in the common peroneal nerve. Neuritis ossificans has the histological appearance of myositis ossificans and follows a similar clinical course. The success of conservative treatment in this case suggests that the potential complications of surgical excision can be avoided.

A longitudinal study of Bartonella infection in populations of woodrats and their fleas

Rodent-borne bartonellae have been identified as human pathogens. Little is known about Bartonella infections in woodrat hosts and their fleas and how woodrat-flea associations may affect the dynamics of Bartonella infections. We collected blood samples and fleas from two species of woodrats (Neotoma micropus and N. albigula) from Santa Fe County, NM, from 2002-2005. The most predominant flea species were Orchopeas sexdentatus and O. neotomae. Bartonella prevalence in woodrats was 64% overall, with a lower prevalence occurring in the pre-reproductive period compared to the early and late reproductive periods. A negative correlation between Bartonella prevalence in N. micropus and weight of N. micropus was observed. Flea load in Neotoma species was highest in the early reproductive period compared to the pre- and late reproductive periods and was higher in N. micropus compared to N. albigula. Bartonella prevalence in fleas was highest in the early reproductive period and lowest in the late reproductive period, and it was higher in fleas collected from N. micropus than in fleas collected from N. albigula. Abundance of O. sexdentatus was significantly higher in N. micropus compared to N. albigula, and abundance of O. sexdentatus and O. neotomae was highest in the early reproductive period. No direct correlations were found either between Bartonella prevalence in woodrats and in fleas or between Bartonella prevalence in woodrats and flea loads. Out of 25 partially characterized Bartonella isolates from Neotoma woodrats, 24 belonged to one genogroup based on sequencing of the gltA gene.

The effect of shot biopsy on behavior, salivary cortisol, and heart rate in slaughter pigs

This paper describes behavioral and physiological responses of pigs to shot biopsy, an experimental method used to study muscle tissue processes or to predict meat quality. One biopsy sample from the longissimus muscle was obtained from 23-wk-old gilts (n = 10) using a cannula connected to a captive bolt. Ten other gilts were used as a control and received a sham shot. One week later, a second biopsy was taken from the same gilts. Behavioral and salivary cortisol responses to both biopsies were similar (P > .10). Pigs flinched in response to the biopsies. Salivary cortisol concentrations were increased (P < .05) 15 min after the biopsy as compared with pretreatment levels, but absolute levels were not different (P > .10) from the control group. In both biopsy and control groups, heart rate increased (P < .001) in response to the presence of the technician. In response to the first biopsy, heart rate increased (P < .01) as compared with the rate during the 5-s period before the biopsy, but heart rate did not increase in response to the second biopsy. The biopsy pigs showed a decrease (P < .05) in initiating contact with the technician in the second test. We conclude that shot biopsy had a significant acute effect on behavior and heart rate. Therefore, the usefulness of this technique in studies in which the behavioral and heart rate responses are measured is limited.

Squamous cell carcinoma of the lip in a 19-month-old child: a case report

Squamous cell carcinoma of the lip is rarely seen in children. We present the case of a 19-month-old child, without known risk factors, who developed invasive squamous cell carcinoma involving the skin and underlying muscle of the lip. The histology of the tumor was invasive squamous cell carcinoma of the keratoacanthoma type. The distinction between this lesion and keratoacanthoma is often difficult and rests on the findings of invasion and significant atypia. Due to the extremely low incidence of squamous cell carcinoma in children, there are few therapeutic guidelines pertaining specifically to infants or children. This patient underwent wide local excision as definitive treatment. Currently, it is 24 months after excision of the tumor and he remains free of clinical recurrence.

The fate of medialized cartilage in thyroplasty type I

Thyroplasty type I is rapidly emerging as the preferred means of medializing a paralyzed vocal fold. We discuss our experience with the fate of a medialized cartilage window 9 months after an otherwise successful operation. Cartilage resorption over time resulted in degeneration of voice and in progressive aspiration. We recommend removing the cartilage window rather than medializing it, in the interest of stabilizing the degree of long-term vocal fold medialization.

Epstein-Barr virus-infected marmoset cells do not form lymphomas in mice with severe combined immunodeficiency

EBV has been associated with several malignancies in humans. EBV can also infect marmoset B lymphocytes, which, as opposed to human B cells, are permissive for lytic Epstein-Barr viral replication. Mice with a severe combined immunodeficiency phenotype (SCID mice) are extremely susceptible to EBV-induced lymphomagenesis when inoculated with EBV-infected lymphocytes. We inoculated SCID mice with human and marmoset lymphoblastoid cells infected with the same EBV isolates. The marmoset cells never gave rise to lymphomas, even after the administration of acyclovir or an anti-natural killer cell antibody and observation periods of up to 16 wk. In contrast, the human lymphoblastoid cells nearly always gave rise to lymphomas within 8 wk. Furthermore, human lymphoblastoid cells genetically engineered to permit lytic EBV replication also readily formed tumors in the SCID mouse. Thus, in this system, it is the cellular milieu that is crucial in determining whether a given lymphoblastoid cell will give rise to a tumor, not the EBV isolate harbored by the cell or whether the virus is permitted to undergo lytic replication.

The role of natural-killer-cells in the pathogenesis of epstein-barr virus-associated burkitt-lymphoma in a scid mouse model

Epstein-Barr virus (EBV) is associated with both benign and malignant lymphoproliferative processes. Recently, mice with severe combined immunodeficiency (SCID) have been described that develop EBV-induced lymphomas when inoculated with peripheral blood lymphocytes from EBV-seropositive individuals. To investigate the pathogenesis of EBV-associated Burkitt lymphomas, we intraperitoneally inoculated SCID mice with cells from EBV-infected Burkitt lymphoma (BL) cell lines. In general, cells from BL lines developed into BL-like tumors. Certain BL cell lines, however, were not particularly tumorigenic in these animals. Antibody capable of depleting mice of natural killer cells (anti-asialo GM1) favored the development of these Burkitt lymphomas. The pathogenetic implications of this animal model for human disease is discussed.

Periodic acid-Schiff-positive organisms in primary cutaneous Bacillus cereus infection. Case report and an investigation of the periodic acid-Schiff staining properties of bacteria

Primary cutaneous Bacillus cereus infection frequently presents as a single necrotic bulla on the extremity of an immunocompromised patient. In lesional biopsy specimens and smears, the large gram-positive rods of B cereus may be mistaken for Clostridium species. This is a potentially serious error, as Bacillus species are resistant to penicillin and other beta-lactam antibiotics. We studied a case in which large periodic acid-Schiff-staining organisms were seen in the biopsy specimen from a necrotic bulla on the finger of a neutropenic patient with diffuse large cell lymphoma. The tissue biopsy specimen subsequently yielded a pure culture of B cereus. Staining with periodic acid-Schiff was then performed on a series of bacterial species in human tissue and from smears of culture colonies. The following bacterial species were found to be consistently periodic acid-Schiff positive after diastase digestion: B cereus, Corynebacterium diphtheriae, Propionibacterium acnes, Klebsiella pneumoniae, and Micrococcus luteus.

Cutaneous metaplastic synovial cyst

Metaplastic synovial cyst, a recently described entity, is histologically characterized by a cystic cavity lined by metaplastic synovial tissue that is often hyperplastic and protrudes into its lumen as villous structures. Clinically, these lesions resemble suture granuloma and develop at the site of previous surgical trauma. We have studied 4 cases of this unusual entity and have investigated the immunohistochemical profile in an effort to determine the nature and derivation of their lining tissue. One of our cases is unique since the lesion was associated with a basal cell carcinoma. A history of previous surgery was noted in one, and history of trauma in 2 of the 4 cases. Our immunohistochemical observations confirmed a mesenchymal derivation for the "synovial like villous structures" but non-availability of a specific "synovial" marker does not permit us to conclude with certainty the synovial nature of the metaplastic tissue. Cutaneous metaplastic synovial cysts are unique lesions which deserve attention and should be included in the differential diagnosis of cutaneous cysts.

[Quantitative prognosis of mortality in newborn infants treated with artificial respiration]

Among the 5 indexes to estimate the mortality rate of ventilated newborns the alveolar-arterial oxygen gradient was elaborated as the best statistical model. By means of the probit method a quantitative estimation regarding mortality prognosis became possible. We could demonstrate that already mean values of the first 6 hours are able to give a very precise prognosis of mortality. Among the variables considered, a reduction of gestational age demonstrated a significant influence on the mortality rate. In contrary diagnoses of respiratory problems showed no influence. An increase in D(Aa)O2 raised mortality rate significantly. Using the D(Aa)O2-model the individual mortality rate for any ventilated newborn within an interval of (0.1) can be given.

Cutaneous gonococcal abscess: a case report

A 29-year-old man was diagnosed as having a gonococcal abscess of the prepuce and urethritis. Such abscesses, caused by fetal monitoring during labor of a mother infected with Neisseria gonorrhoeae, have been observed on the scalp of newborns. If antibiotic treatment is to be effective, these abscesses must be excised and drained.