Publications by authors named "Christine Johnson"

354 Publications

Prenatal IgE as a Risk Factor for the Development of Childhood Neurodevelopmental Disorders.

Front Pediatr 2021 14;9:601092. Epub 2021 May 14.

Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, United States.

Few studies have examined if maternal allergic disease is associated with an offspring's neurodevelopment. We hypothesized that Th-2 biased maternal immune function assessed as total serum immunoglobulin (Ig) E is associated with attention deficit hyperactivity disorder (ADHD). Data are from the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS), a racially and socioeconomically diverse birth cohort in metropolitan Detroit, Michigan. Maternal total IgE was measured prenatally and at 1-month postpartum. Child total IgE was assessed at birth, 6 months, and 2 years of age. ADHD diagnosis was based on the parental report at the 10-12-year study visits or medical chart abstraction. Total IgE was log transformed. Poisson regression models with robust error variance were used to calculate the risk ratios (RR). Inverse probability weighting was used to correct for potential bias due to a loss to follow-up and non-response. Of the 636 maternal-child pairs in the analysis, 513 children were neurotypical and 123 had ADHD. Maternal prenatal total IgE was significantly associated with ADHD even after adjustment for potential confounders (RR = 1.08, 95% CI 1.03-1.13). Maternal and child IgE measures were positively and significantly correlated, but child total IgE was not associated with ADHD at any time point. Maternal prenatal IgE may influence neurodevelopment, but additional studies are needed to confirm and expand these findings.
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http://dx.doi.org/10.3389/fped.2021.601092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160239PMC
May 2021

SPR Perspectives: scientific opportunities in the Environmental influences on Child Health Outcomes Program.

Pediatr Res 2021 May 25. Epub 2021 May 25.

Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.

Drawing upon extant data from existing pediatric cohorts and new follow-up of a diverse set of pediatric cohorts from across the United States, the Environmental influences on Child Health Outcomes (ECHO) Program creates the opportunity for novel and innovative investigations of many previously inaccessible scientific questions in the area of child health. We describe how the large sample size, diversity of participants, emphasis on team science, and infrastructure for improving research methodology make the ECHO Program a major research resource for improving our understanding of early life determinants of childhood health and well-being. Pediatric researchers leverage the unique features of the ECHO Program to address research questions with the potential to yield far-reaching and long-term impacts on child health. IMPACT: The ECHO Program unites pediatric cohorts from across the United States, allowing for investigations of compelling research questions that were previously infeasible due to limited sample sizes or lack of participant diversity. The focus of the ECHO Program on team science, solution-oriented research, and methodological innovation propels novel scientific investigations that are responsive to the needs of a wide range of stakeholders. Features of the ECHO program's infrastructure poise its investigators to rapidly launch research endeavors that are responsive to time-sensitive and critical needs within the realm of pediatric research.
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http://dx.doi.org/10.1038/s41390-021-01577-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145190PMC
May 2021

SARS-CoV-2 RT-PCR positivity and antibody prevalence among asymptomatic hospital-based health care workers.

J Clin Virol 2021 07 16;140:104794. Epub 2021 Mar 16.

Department of Pathology, Henry Ford Health System, Detroit, MI, United States.

Background: The level of asymptomatic infection with SARS-CoV-2 could be substantial and among health care workers (HCWs) a source of continuing transmission of the virus to patients and co-workers.

Objectives: Measure the period prevalence of SARS-CoV-2 PCR positivity and seroprevalence of SARS-CoV-2 IgG antibodies among a random sample of asymptomatic health system hospital-based health care workers (HCWs) 6½ -15½ weeks after 4/5/2020, the peak of the first surge of COVID-19 admissions.

Results: Of 524 eligible and consented participants from four metropolitan hospitals, nasopharyngeal swabs were obtained from 439 (83.8 %) and blood from 374 (71.4 %). Using PCR nucleic acid-based amplification (NAAT) methods, the period prevalence of SARS-CoV-2 infection was 0.23 % (95 % confidence interval (CI) 0.01 %-1.28 %; 1/439) from 5/21/20-7/16/20. The seroprevalence of SARS-CoV-2 IgG antibodies from June 17-July 24, 2020 was 2.41 % (95 % CI 1.27 %-4.51 %; 9/374). Those who were reactive were younger (median age 36 versus 44 years; p = 0.050), and those with self-reported Hispanic/Latino ethnicity had a higher seroprevalence (2/12 = 16.7 % versus 7/352 = 2.0 %; p = 0.051). There were no significant differences by sex, race, residence, hospital, unit or job type. The one employee who was found to be PCR test positive in this study was also reactive for IgG antibodies, tested 27 days later.

Conclusions: The period prevalence of PCR positivity to SARS-CoV-2 and IgG seroprevalence was unexpectedly low in asymptomatic HCWs after a peak in COVID-19 admissions and the establishment of state and institutional infection control policies, suggesting that routine screening tests while community prevalence is relatively low would produce a minimal yield.
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http://dx.doi.org/10.1016/j.jcv.2021.104794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962992PMC
July 2021

Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar.

Emerg Infect Dis 2021 Jun;27(6):1709-1713

Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Asia, infecting many animal hosts, but CCHFV has not been reported in Myanmar. We conducted a seroepidemiologic survey of logging communities in Myanmar and found CCHFV exposure was common (9.8%) and exposure to wild animal blood and body fluids was associated with seropositivity.
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http://dx.doi.org/10.3201/eid2706.203223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8153884PMC
June 2021

A distributed geospatial approach to describe community characteristics for multisite studies.

J Clin Transl Sci 2021 Feb 5;5(1):e86. Epub 2021 Feb 5.

Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.

Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
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http://dx.doi.org/10.1017/cts.2021.7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8111696PMC
February 2021

US Childhood Asthma Incidence Rate Patterns From the ECHO Consortium to Identify High-Risk Groups for Primary Prevention.

JAMA Pediatr 2021 May 17:e210667. Epub 2021 May 17.

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.

Importance: Asthma is the leading chronic illness in US children, but most descriptive epidemiological data are focused on prevalence.

Objective: To evaluate childhood asthma incidence rates across the nation by core demographic strata and parental history of asthma.

Design, Setting, And Participants: For this cohort study, a distributed meta-analysis was conducted within the Environmental Influences on Child Health Outcomes (ECHO) consortium for data collected from May 1, 1980, through March 31, 2018. Birth cohort data of children from 34 gestational weeks of age or older to 18 years of age from 31 cohorts in the ECHO consortium were included. Data were analyzed from June 14, 2018, to February 18, 2020.

Exposures: Caregiver report of physician-diagnosed asthma with age of diagnosis.

Main Outcome And Measures: Asthma incidence survival tables generated by each cohort were combined for each year of age using the Kaplan-Meier method. Age-specific incidence rates for each stratum and asthma incidence rate ratios by parental family history (FH), sex, and race/ethnicity were calculated.

Results: Of the 11 404 children (mean [SD] age, 10.0 [0.7] years; 5836 boys [51%]; 5909 White children [53%]) included in the primary analysis, 7326 children (64%) had no FH of asthma, 4078 (36%) had an FH of asthma, and 2494 (23%) were non-Hispanic Black children. Children with an FH had a nearly 2-fold higher incidence rate through the fourth year of life (incidence rate ratio [IRR], 1.94; 95% CI, 1.76-2.16) after which the rates converged with the non-FH group. Regardless of FH, asthma incidence rates among non-Hispanic Black children were markedly higher than those of non-Hispanic White children during the preschool years (IRR, 1.58; 95% CI, 1.31-1.86) with no FH at age 4 years and became lower than that of White children after age 9 to 10 years (IRR, 0.67; 95% CI, 0.50-0.89) with no FH. The rates for boys declined with age, whereas rates among girls were relatively steady across all ages, particularly among those without an FH of asthma.

Conclusions And Relevance: Analysis of these diverse birth cohorts suggests that asthma FH, as well as race/ethnicity and sex, were all associated with childhood asthma incidence rates. Black children had much higher incidences rates but only during the preschool years, irrespective of FH. To prevent asthma among children with an FH of asthma or among Black infants, results suggest that interventions should be developed to target early life.
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http://dx.doi.org/10.1001/jamapediatrics.2021.0667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8129904PMC
May 2021

Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats.

One Health Outlook 2021 May 14;3(1):11. Epub 2021 May 14.

One Health Institute, University of California, Davis, One Shields Ave, Davis, CA, 95616, USA.

In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development's (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security.
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http://dx.doi.org/10.1186/s42522-021-00036-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122533PMC
May 2021

Aspirin, ibuprofen, and reduced risk of advanced colorectal adenoma incidence and recurrence and colorectal cancer in the PLCO Cancer Screening Trial.

Cancer 2021 May 11. Epub 2021 May 11.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Background: Studying the differential impact of aspirin and other nonsteroidal anti-inflammatory drugs across the stages of colorectal neoplasia from early adenoma to cancer is critical for understanding the benefits of these widely used drugs.

Methods: With 13 years of follow-up, the authors prospectively evaluated the association between aspirin and ibuprofen use and incident distal adenoma (1221 cases), recurrent adenoma (862 cases), and incident colorectal cancer (CRC; 2826 cases) among men and women in the population-based Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. With multivariable-adjusted models, odds ratio (ORs) and 95% confidence intervals (CIs) for adenoma incidence and recurrence and hazard ratios (HRs) and 95% CIs for incident CRC were determined.

Results: The authors observed a significantly reduced risk of incident adenoma with ibuprofen use (≥30 vs <4 pills per month: OR, 0.76 [95% CI, 0.60-0.95]; P = .04), particularly advanced adenoma (OR, 0.48 [95% CI, 0.28-0.83]; P = .005). Among those with a previous adenoma detected through screening, aspirin use was associated with a decreased risk of advanced recurrent adenoma (≥30 vs <4 pills per month: OR, 0.56 [95% CI, 0.36-0.87]; P = 0.006). Both aspirin (HR, 0.88 [95% CI, 0.81-0.96]; P <.0001) and ibuprofen use (HR, 0.81 [95% CI, 0.70-0.93); P = 0.003) ≥30 versus <4 pills per month were significantly associated with reduced CRC risk.

Conclusions: In this large prospective study with long-term follow-up, a beneficial role for not only aspirin, but also ibuprofen, in preventing advanced adenoma and curbing progression to recurrence and cancer among older adults was observed.
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http://dx.doi.org/10.1002/cncr.33623DOI Listing
May 2021

Increased risk of asthma at age 10 years for children sensitized to multiple allergens.

Ann Allergy Asthma Immunol 2021 May 8. Epub 2021 May 8.

Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.

Background: Childhood sensitization patterns have been previously found to be related to variable risk of early life allergic disease in several birth cohorts.

Objective: To determine whether these risks persist into later childhood.

Methods: In the birth cohort of the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study, previous latent class analysis based on sensitization to 10 allergens found the following 4 early life sensitization patterns at age 2 years: "highly sensitized," "milk/egg dominated," "peanut and inhalant(s)," and "low to no sensitization." At an age 10 study-specific visit, children were evaluated by an allergist for current asthma and atopic dermatitis through a physical examination and interviews with the child and parent or guardian. Total and specific immunoglobulin E (IgE), spirometry, and methacholine challenge were also completed.

Results: Compared with children sensitized to none or 1 allergen, children sensitized to 4 or more food and inhalant allergens at age 2 had the highest risk of current asthma (relative risk [RR], 4.42; 95% confidence interval [CI], 2.58-7.59; P < .001) and bronchial hyperresponsiveness (RR, 1.77; 95% CI, 1.29-2.42; P < .001). In addition, they had the highest levels of total IgE (geometric mean, 800 IU/mL; 95% CI, 416-1536) among the 4 groups. Risk of current atopic dermatitis did not depend on pattern of sensitization but remained increased for children with any sensitization (RR, 2.23; 95% CI, 1.40-3.55; P < .001). No differences in spirometry (forced expiratory volume in 1 second, forced expiratory flow between 25% and 75%, and forced expiratory volume in 1 second/forced vital capacity) were identified.

Conclusion: The previously reported importance of a specific pattern of sensitization in early life (sensitization to ≥4 inhalant and food allergens) continues to be associated with an increased risk of asthma, bronchial hyperresponsiveness, and high total IgE at age 10 years.
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http://dx.doi.org/10.1016/j.anai.2021.04.028DOI Listing
May 2021

Possible impacts of molten salt reactors on the International Monitoring System.

J Environ Radioact 2021 Aug 6;234:106622. Epub 2021 May 6.

Pacific Northwest National Laboratory, 902 Battelle Blvd., Richland, WA, 99354, USA. Electronic address:

Molten salt reactors (MSRs) are gaining support as many countries look for ways to increase power generation and replace aging nuclear energy production facilities. MSRs have inherently safe designs, are scalable in size, can burn transuranic wastes from traditional solid fuel nuclear reactors, can store excess heat in thermal reservoirs for water desalination, and can be used to produce medical isotopes as part of the real-time liquid-fuel recycling process. The ability to remove Xe in real time from the fuel improves the power production in an MSR because Xe is the most significant neutron-absorbing isotope generated by nuclear fission. Xenon-135, and other radioactive gases, are removed by sparging the fuel with an inert gas while the liquid fuel is recirculated from the reactor inner core through the heat exchangers. Without effective abatement technologies, large amounts of radioactive gas could be released during the sparging process. This work examines the potential impact of radioxenon releases on samplers used by the International Monitoring System (IMS) to detect nuclear explosions. Atmospheric transport simulations from seven hypothetical MSRs on different continents were used to evaluate the holdup time needed before release of radioxenon so IMS samplers would register few detections. Abatement technologies that retain radioxenon isotopes for at least 120 d before their release will be needed to mitigate the impacts from a molten salt breeder reactor used to replace a nuclear power plant. A holdup time of about 150 d is needed to reduce emissions to the average level of current nuclear power plants.
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http://dx.doi.org/10.1016/j.jenvrad.2021.106622DOI Listing
August 2021

Pediatric Asthma Incidence Rates in the United States from 1980-2017.

J Allergy Clin Immunol 2021 May 5. Epub 2021 May 5.

Background: Few studies have examined longitudinal asthma incidence rates from a public health surveillance perspective.

Objective: Calculate descriptive asthma incidence rates in children over time considering demographics and parental asthma history.

Methods: Data from nine US birth cohorts were pooled into one population covering 1980-2017. The outcome was earliest parental report of a doctor diagnosis of asthma. Incidence rates per 1,000 person-years were calculated.

Results: The 6,283 children were 55% European-American (EA), 25.5% African-American (AA), 9.5% Mexican-Hispanic American (MA) and 8.5% Caribbean-Hispanic American (CA). Average follow-up was 10.4 years (SD=8.5 years, median=8.4) totaling 65,291 person-years, with 1789 asthma diagnoses yielding a crude incidence rate of 27.5 per 1000 person-years (95% CI 26.3-28.8). Age-specific rates were highest among children 0-4 years, notably from 1995-1999, with a decline in EA/MAs in 2000-2004 followed by a decline in AA/CAs in 2010-2014. Parental asthma history was associated with statistically significantly increased rates. Incidence rates were similar and higher in AA and CA compared to lower but similar rates in EA and MA. Differential rates by sex from birth through adolescence principally resulted from a decline in male but relatively stable female rates.

Conclusions: US childhood asthma incidence rates varied dramatically by age, sex, parental asthma history, race and calendar year. Higher rates in the 0-4 year-olds, particularly in AA/CA males with a parental history, and changes in rates over time and by demographic factors, suggests that asthma is driven by complex interactions between genetic susceptibility and variation in time-dependent environmental and social factors.
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http://dx.doi.org/10.1016/j.jaci.2021.04.027DOI Listing
May 2021

Modeling of fission and activation products in molten salt reactors and their potential impact on the radionuclide monitoring stations of the International Monitoring System.

J Environ Radioact 2021 Aug 3;234:106625. Epub 2021 May 3.

Pacific Northwest National Laboratory, Richland, WA, USA.

Molten Salt Reactors (MSRs) are one of six Generation IV reactor designs currently under development around the world. Because of the unique operating conditions of MSRs, which include molten fuel and the continuous removal of gaseous fission products during operation, work was performed to model the production of activation and fission products and analyze the potential impact of emissions on the International Monitoring System (IMS) of the Comprehensive Nuclear-Test-Ban Treaty (CTBT). Simulations were performed to predict the production of IMS-relevant radionuclides in four MSR designs operating under two scenarios: (1) a sealed reactor with releases only during operational shutdown, and (2) continuous reprocessing or sparging of the fuel salt. From these production estimates the radioxenon and radioiodine signatures were extracted and compared to three current reactor designs (Boiling Water Reactor, Pressurized Water Reactor, High-Power Channel-Type Reactor). In cases where continuous reprocessing of the fuel salt occurred, both the radioxenon and radioiodine signatures were nearly indistinguishable from a nuclear explosion. Estimates were also made of the potential emission rate of radioxenon for three reactor designs and it was found that MSRs have the potential to emit radioxenon isotopes at a rate of 10-8×10 Bq/d for Xe, which may adversely affect nuclear explosion monitoring, if no abatement is used. An assessment was made of activation products using a candidate fuel salt (FLiBe) mixed with corrosion products for the Thorium Molten Salt Reactor (TMSR-LF1).
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http://dx.doi.org/10.1016/j.jenvrad.2021.106625DOI Listing
August 2021

Retrospective study on admission trends of Californian hummingbirds found in urban habitats (1991-2016).

PeerJ 2021 13;9:e11131. Epub 2021 Apr 13.

Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA.

Background: Hummingbirds are frequently presented to California wildlife rehabilitation centers for medical care, accounting for approximately 5% of overall admissions. Age, sex, and reason for admission could impact hummingbird survivability, therefore identification of these factors could help maximize rehabilitation efforts.

Methods: Mixed-effects logistic regression models were used to identify specific threats to the survival of 6908 hummingbirds (1645 nestlings and 5263 non-nestlings) consisting of five species (), found in urban settings, and admitted to California wildlife rehabilitation centers over 26 years.

Results: In total, 36% of birds survived and were transferred to flight cage facilities for further rehabilitation and/or release. Nestlings were more likely to be transferred and/or released compared to adult hummingbirds. After accounting for age, birds rescued in spring and summer were twice as likely to be released compared to birds rescued in the fall. A high number of nestlings were presented to the rehabilitation centers during spring, which coincides with the nesting season for hummingbirds in California, with the lowest number of nestlings presented in fall. Reasons for presentation to rehabilitation centers included several anthropogenic factors such as window collisions (9.6%) and interactions with domesticated animals (12.9%). Survival odds were lower if a hummingbird was rescued in a "torpor-like state" and were higher if rescued for "nest-related" reasons. Evaluation of treatment regimens administered at wildlife rehabilitation centers identified supportive care, including providing commercial nutrient-rich nectar plus solution, to significantly increase hummingbird survivability.

Discussion: Our results provide evidence of threats to hummingbirds in urban habitats, based on reasons for rescue and presentation to rehabilitation centers. Reasons for hummingbird admissions to three California wildlife rehabilitation centers were anthropogenic in nature (i.e., being associated with domestic animals, window collisions, and found inside a man-made structure) and constituted 25% of total admissions. There was a clear indication that supportive care, such as feeding a commercial nectar solution, and medical treatment significantly increased the odds of survival for rescued hummingbirds.
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http://dx.doi.org/10.7717/peerj.11131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051342PMC
April 2021

Clinical placements in General Practice: concepts and considerations of implementing remote virtual placements in the COVID world.

Educ Prim Care 2021 Apr 10:1-8. Epub 2021 Apr 10.

Community Sub-Dean in Primary Care, University of Nottingham, UK.

Medical students are considered as 'essential workers' within the National Health Service (NHS) and the delivery of clinical experience is essential to their learning and progression into the workforce. The COVID-19 pandemic impacted the delivery of clinical placements in primary care; GPs are currently delivering the majority of consultations using telephone or video methods and difficulties in attaining placement experience are being encountered by medical students. Virtual remote consultations are an appropriate adjunct to conventional face-to-face patient encounters and could facilitate students to attain core learning outcomes. This article describes some of the approaches that enable remote (home) virtual patient encounters in Primary Care for medical students. These are categorised as methods that a) enable remote access into GP clinical systems, b) enable remote access into individual patient consultations and c) enable an observational-only experience. Key considerations are highlighted to enable safe and effective implementation of remote virtual consultations, along with the advantages and disadvantages of each method. These include patient consent, confidentiality, data sharing and protection, professionalism, student agreements and data gathering templates. It is hoped that sharing of these methods of virtual consulting will support the ongoing delivery of Primary Care education across medical schools.
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http://dx.doi.org/10.1080/14739879.2021.1907790DOI Listing
April 2021

Ranking the risk of animal-to-human spillover for newly discovered viruses.

Proc Natl Acad Sci U S A 2021 04;118(15)

One Health Institute and Karen C. Drayer Wildlife Health Center, School of Veterinary Medicine, University of California, Davis, CA 95616;

The death toll and economic loss resulting from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic are stark reminders that we are vulnerable to zoonotic viral threats. Strategies are needed to identify and characterize animal viruses that pose the greatest risk of spillover and spread in humans and inform public health interventions. Using expert opinion and scientific evidence, we identified host, viral, and environmental risk factors contributing to zoonotic virus spillover and spread in humans. We then developed a risk ranking framework and interactive web tool, SpillOver, that estimates a risk score for wildlife-origin viruses, creating a comparative risk assessment of viruses with uncharacterized zoonotic spillover potential alongside those already known to be zoonotic. Using data from testing 509,721 samples from 74,635 animals as part of a virus discovery project and public records of virus detections around the world, we ranked the spillover potential of 887 wildlife viruses. Validating the risk assessment, the top 12 were known zoonotic viruses, including SARS-CoV-2. Several newly detected wildlife viruses ranked higher than known zoonotic viruses. Using a scientifically informed process, we capitalized on the recent wealth of virus discovery data to systematically identify and prioritize targets for investigation. The publicly accessible SpillOver platform can be used by policy makers and health scientists to inform research and public health interventions for prevention and rapid control of disease outbreaks. SpillOver is a living, interactive database that can be refined over time to continue to improve the quality and public availability of information on viral threats to human health.
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http://dx.doi.org/10.1073/pnas.2002324118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053939PMC
April 2021

Preventing the next pandemic: the power of a global viral surveillance network.

BMJ 2021 03 12;372:n485. Epub 2021 Mar 12.

Thai Red Cross Emerging Infectious Diseases Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn University, Pathumwan, Thailand.

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http://dx.doi.org/10.1136/bmj.n485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7953426PMC
March 2021

The Milk Metabolome of Non-secretor and Lewis Negative Mothers.

Front Nutr 2020 2;7:576966. Epub 2021 Feb 2.

Department of Food Science and Technology, University of California, Davis, Davis, CA, United States.

The functional role of milk for the developing neonate is an area of great interest, and a significant amount of research has been done. However, a lot of work remains to fully understand the complexities of milk, and the variations imposed through genetics. It has previously been shown that both secretor (Se) and Lewis blood type (Le) status impacts the human milk oligosaccharide (HMO) content of human milk. While some studies have compared the non-HMO milk metabolome of Se+ and Se- women, none have reported on the non-HMO milk metabolome of Se- and Le- mothers. To determine the differences in the non-HMO milk metabolome between Se-Le- mothers and other HMO phenotypes (Se+Le+, Se+Le-, and Se-Le+), 10 milk samples from 10 lactating mothers were analyzed using nuclear magnetic resonance (NMR) spectroscopy. Se or Le HMO phenotypes were assigned based on the presence and absence of 6 HMOs generated by the Se and Le genes. After classification, 58 milk metabolites were compared among the HMO phenotypes. Principal component analysis (PCA) identified clear separation between Se-Le- milk and the other milks. Fold change analysis demonstrated that the Se-Le- milk had major differences in free fatty acids, free amino acids, and metabolites related to energy metabolism. The results of this brief research report suggest that the milk metabolome of mothers with the Se-Le- phenotype differs in its non-HMO metabolite composition from mothers with other HMO phenotypes.
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http://dx.doi.org/10.3389/fnut.2020.576966DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901958PMC
February 2021

Infant Feeding Practices and Subsequent Dietary Patterns of School-Aged Children in a US Birth Cohort.

J Acad Nutr Diet 2021 Jun 21;121(6):1064-1079. Epub 2020 Oct 21.

Background: Infant feeding practices are thought to shape food acceptance and preferences. However, few studies have evaluated whether these affect child diet later in life.

Objective: The study objective was to examine the association between infant feeding practices and dietary patterns (DPs) in school-aged children.

Design: A secondary analysis of data from a diverse prospective birth cohort with 10 years of follow-up (WHEALS [Wayne County Health Environment Allergy and Asthma Longitudinal Study]) was conducted.

Participants/setting: Children from the WHEALS (Detroit, MI, born 2003 through 2007) who completed a food screener at age 10 years were included (471 of 1,258 original participants).

Main Outcome Measures: The main outcome was DPs at age 10 years, identified using the Block Kids Food Screener.

Statistical Analysis Performed: Latent class analysis was applied for DP identification. Breastfeeding and age at solid food introduction were associated with DPs using a 3-step approach for latent class modeling based on multinomial logistic regression models.

Results: The following childhood DPs were identified: processed/energy-dense food (35%), variety plus high intake (41%), and healthy (24%). After weighting for loss to follow-up and covariate adjustment, compared with formula-fed children at 1 month, breastfed children had 0.41 times lower odds of the processed/energy-dense food DP vs the healthy DP (95% CI 0.14 to 1.25) and 0.53 times lower odds of the variety plus high intake DP (95% CI 0.17 to 1.61), neither of which were statistically significant. Results were similar, but more imprecise, for breastfeeding at 6 months. In addition, the association between age at solid food introduction and DP was nonsignificant, with each 1-month increase in age at solid food introduction associated with 0.81 times lower odds of the processed/energy-dense food DP relative to the healthy DP (95% CI 0.64 to 1.02).

Conclusions: A significant association between early life feeding practices and dietary patterns at school age was not detected. Large studies with follow-up beyond early childhood that can also adjust for the multitude of potential confounders associated with breastfeeding are needed.
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http://dx.doi.org/10.1016/j.jand.2020.08.083DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058109PMC
June 2021

Exposure to domoic acid is an ecological driver of cardiac disease in southern sea otters.

Harmful Algae 2021 01 12;101:101973. Epub 2021 Jan 12.

Karen C. Drayer Wildlife Health Center and EpiCenter for Disease Dynamics, One Health Institute, University of California Davis School of Veterinary Medicine, 1089 Veterinary Medicine Dr. VM3B, Davis, CA, United States. Electronic address:

Harmful algal blooms produce toxins that bioaccumulate in the food web and adversely affect humans, animals, and entire marine ecosystems. Blooms of the diatom Pseudo-nitzschia can produce domoic acid (DA), a toxin that most commonly causes neurological disease in endothermic animals, with cardiovascular effects that were first recognized in southern sea otters. Over the last 20 years, DA toxicosis has caused significant morbidity and mortality in marine mammals and seabirds along the west coast of the USA. Identifying DA exposure has been limited to toxin detection in biological fluids using biochemical assays, yet measurement of systemic toxin levels is an unreliable indicator of exposure dose or timing. Furthermore, there is little information regarding repeated DA exposure in marine wildlife. Here, the association between long-term environmental DA exposure and fatal cardiac disease was investigated in a longitudinal study of 186 free-ranging sea otters in California from 2001 - 2017, highlighting the chronic health effects of a marine toxin. A novel Bayesian spatiotemporal approach was used to characterize environmental DA exposure by combining several DA surveillance datasets and integrating this with life history data from radio-tagged otters in a time-dependent survival model. In this study, a sea otter with high DA exposure had a 1.7-fold increased hazard of fatal cardiomyopathy compared to an otter with low exposure. Otters that consumed a high proportion of crab and clam had a 2.5- and 1.2-times greater hazard of death due to cardiomyopathy than otters that consumed low proportions. Increasing age is a well-established predictor of cardiac disease, but this study is the first to identify that DA exposure affects the risk of cardiomyopathy more substantially in prime-age adults than aged adults. A 4-year-old otter with high DA exposure had 2.3 times greater risk of fatal cardiomyopathy than an otter with low exposure, while a 10-year old otter with high DA exposure had just 1.2 times greater risk. High Toxoplasma gondii titers also increased the hazard of death due to heart disease 2.4-fold. Domoic acid exposure was most detrimental for prime-age adults, whose survival and reproduction are vital for population growth, suggesting that persistent DA exposure will likely impact long-term viability of this threatened species. These results offer insight into the pervasiveness of DA in the food web and raise awareness of under-recognized chronic health effects of DA for wildlife at a time when toxic blooms are on the rise.
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http://dx.doi.org/10.1016/j.hal.2020.101973DOI Listing
January 2021

Social distancing during the COVID-19 pandemic: quantifying the practice in Michigan - a "hotspot state" early in the pandemic - using a volunteer-based online survey.

BMC Public Health 2021 01 29;21(1):245. Epub 2021 Jan 29.

Department of Public Health Sciences, Henry Ford Hospital, 1 Ford Place, 5C, Detroit, MI, 48202, USA.

Background: Public Health policies related to social distancing efforts during the COVID-19 pandemic helped slow the infection rate. However, individual-level factors associated with social distancing are largely unknown. We sought to examine social distancing during the COVID-19 pandemic in Michigan, an infection "hotspot" state in the United States early in the pandemic.

Methods: Two surveys were distributed to Michigan residents via email lists and social media following COVID-19 related state mandates in March; 45,691 adults responded to the first survey and 8512 to the second. Staying home ≥ 3 out of 5 previous days defined having more social distancing. Logistic regression models were used to examine potential factors associated with more social distancing.

Results: Most respondents were women (86% in Survey 1, 87% in Survey 2). In Survey 1, 63% reported more social distancing, increasing to 78% in Survey 2. Female sex and having someone (or self) sick in the home were consistently associated with higher social distancing, while increasing age was positively associated in Survey 1 but negatively associated in Survey 2. Most respondents felt social distancing policies were important (88% in Survey 1; 91% in Survey 2).

Conclusions: Michiganders responding to the surveys were both practicing and supportive of social distancing. State-level executive orders positively impacted behaviors early in the COVID-19 pandemic in Michigan. Additional supports are needed to help vulnerable populations practice social distancing, including older individuals.
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http://dx.doi.org/10.1186/s12889-021-10287-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844797PMC
January 2021

Infectious Disease Threats: A Rebound To Resilience.

Health Aff (Millwood) 2021 02 21;40(2):204-211. Epub 2021 Jan 21.

Michael T. Osterholm is the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in Minneapolis, Minnesota.

The US has experienced a series of epidemics during the past five decades. None has tested the nation's resilience like the coronavirus disease 2019 (COVID-19) pandemic, which has laid bare critical weaknesses in US pandemic preparedness and domestic leadership and the nation's decline in global standing in public health. Pandemic response has been politicized, proven public health measures undermined, and public confidence in a science-based public health system reduced. This has been compounded by the large number of citizens without ready access to health care, who are overrepresented among infected, hospitalized, and fatal cases. Here, as part of the National Academy of Medicine's Vital Directions for Health and Health Care: Priorities for 2021 initiative, we review the US approach to pandemic preparedness and its impact on the response to COVID-19. We identify six steps that should be taken to strengthen US pandemic resilience, strengthen and modernize the US health care system, regain public confidence in government leadership in public health, and restore US engagement and leadership in global partnerships to address future pandemic threats domestically and around the world.
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http://dx.doi.org/10.1377/hlthaff.2020.01544DOI Listing
February 2021

Targeted Muscle Reinnervation: A Paradigm Shift for Neuroma Management and Improved Prosthesis Control in Major Limb Amputees.

J Am Acad Orthop Surg 2021 04;29(7):288-296

From the OrthoCarolina Hand Center, Charlotte, North Carolina (Johnson), Atrium Musculoskeletal Institute, the OrthoCarolina Hand Center, Charlotte, North Carolina (Loeffler), and the Atrium Musculoskeletal Institute, OrthoCarolina Hand and Upper Extremity Fellowship, Charlotte, North Carolina (Gaston).

Targeted muscle reinnervation (TMR) is a procedure that redirects nerves severed by amputation to new muscle targets. In tandem with advances in myoelectric prosthetics, TMR surgery provides amputees with improved control of myoelectric prostheses and simultaneously prevents or treats painful neuromas. TMR also has an emerging role in the management of neuromas in a nonamputation setting, and it seems to be a powerful strategy to treat a wide variety of neuromas. Because the pattern of nerve transfers varies based on the availability of donor nerves and muscle targets, TMR is inherently nonprescriptive, and thus, an understanding of the principles of TMR is essential for its successful application. This review describes the rationale for and principles of TMR, and outlines techniques for TMR, which can be used at various amputation levels and for the management of neuromas in nonamputees.
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http://dx.doi.org/10.5435/JAAOS-D-20-00044DOI Listing
April 2021

Vulnerabilities for Exposure to Emerging Infectious Disease at Urban Settlements in Nepal.

Ecohealth 2020 09 18;17(3):345-358. Epub 2020 Nov 18.

One Health Institute, University of California, Davis, USA.

In Nepal, rapid urbanization and rural-to-urban migration especially due to internal civil conflict have catalyzed the development of temporary settlements, often along rivers on undeveloped land. This study conducted surveillance for viruses in small mammals and assessed potential risks for virus transmission to people in urban settlements along rivers in Kathmandu, Nepal. We collected samples from 411 small mammals (100 rodents and 311 shrews) at four riverside settlement sites and detected six viruses from four virus families including Thottapalayam virus; a strain of murine coronavirus; two new paramyxoviruses; and two new rhabdoviruses. Additionally, we conducted surveys of 264 residents to characterize animal-human contact. Forty-eight percent of individuals reported contact with wildlife, primarily with rodents and shrews (91%). Our findings confirm that rodents and shrews should be considered a health threat for residents of temporary settlements, and that assessment of disease transmission risk coupled with targeted surveillance for emerging pathogens could lead to improved disease control and health security for urban populations. Additionally, interventions focused on disease prevention should consider the unique urban ecology and social dynamics in temporary settlements, along with the importance of community engagement for identifying solutions that address specific multi-dimensional challenges that life on the urban river margins presents.
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http://dx.doi.org/10.1007/s10393-020-01499-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7672689PMC
September 2020

Spillover of ebolaviruses into people in eastern Democratic Republic of Congo prior to the 2018 Ebola virus disease outbreak.

One Health Outlook 2020 4;2(1):21. Epub 2020 Nov 4.

One Health Institute & Karen C Drayer Wildlife Health Center, School of Veterinary Medicine, University of California Davis, California, USA.

Background: The second largest Ebola virus disease (EVD) outbreak began in the Democratic Republic of Congo in July 2018 in North Kivu Province. Data suggest the outbreak is not epidemiologically linked to the 2018 outbreak in Equateur Province, and that independent introduction of Ebola virus (EBOV) into humans occurred. We tested for antibodies to ebolaviruses in febrile patients seeking care in North Kivu Province prior to the EVD outbreak.

Methods: Patients were enrolled between May 2017 and April 2018, before the declared start of the outbreak in eastern DRC. Questionnaires were administered to collect demographic and behavioural information to identify risk factors for exposure. Biological samples were evaluated for ebolavirus nucleic acid, and for antibodies to ebolaviruses. Prevalence of exposure was calculated, and demographic factors evaluated for associations with ebolavirus serostatus.

Results: Samples were collected and tested from 272 people seeking care in the Rutshuru Health Zone in North Kivu Province. All patients were negative for filoviruses by PCR. Intial screening by indirect ELISA found that 30 people were reactive to EBOV-rGP. Results were supported by detection of ebolavirus reactive linear peptides using the Serochip platform. Differential screening of all reactive serum samples against the rGP of all six ebolaviruses and Marburg virus (MARV) showed that 29 people exhibited the strongest reactivity to EBOV and one to Bombali virus (BOMV), and western blotting confirmed results. Titers ranged from 1:100 to 1:12,800. Although both sexes and all ages tested positive for antibodies, women were significantly more likely to be positive and the majority of positives were in February 2018.

Conclusions: We provide the first documented evidence of exposure to Ebola virus in people in eastern DRC. We detected antibodies to EBOV in 10% of febrile patients seeking healthcare prior to the declaration of the 2018-2020 outbreak, suggesting early cases may have been missed or exposure ocurred without associated illness. We also report the first known detection of antibodies to BOMV, previously detected in bats in West and East Africa, and show that human exposure to BOMV has occurred. Our data suggest human exposure to ebolaviruses may be more frequent and geographically widespread.
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http://dx.doi.org/10.1186/s42522-020-00028-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7609368PMC
November 2020

Maternal and cord blood vitamin D level and the infant gut microbiota in a birth cohort study.

Matern Health Neonatol Perinatol 2020 20;6. Epub 2020 Oct 20.

Department of Public Health Sciences, Henry Ford Hospital, 1 Ford Place, 5C, Detroit, MI 48202 USA.

Background: Mounting evidence suggests both vitamin D and the early life gut microbiome influence childhood health outcomes. However, little is known about how these two important exposures are related. We aimed to examine associations between plasma 25-hydroxyvitamin D (25[OH]D) levels during pregnancy or at delivery (cord blood) and infant gut microbiota.

Methods: Maternal and cord blood 25[OH]D levels were assessed in a sample of pregnant women. Compositional analyses adjusted for race were run on the gut microbiota of their offspring at 1 and 6 months of age.

Results: Mean prenatal 25(OH)D level was 25.04 ± 11.62 ng/mL and mean cord blood 25(OH)D level was 10.88 ± 6.77 ng/mL. Increasing prenatal 25(OH)D level was significantly associated with decreased richness ( = 0.028) and diversity ( = 0.012) of the gut microbiota at 1 month of age. Both prenatal and cord 25(OH)D were significantly associated with 1 month microbiota composition. A total of 6 operational taxonomic units (OTUs) were significantly associated with prenatal 25(OH)D level (four positively and two negatively) while 11 OTUs were significantly associated with cord 25(OH)D (10 positively and one negatively). Of these, OTU 93 () and OTU 210 () were consistently positively associated with maternal and cord 25(OH)D; OTU 64 () was positively associated with prenatal 25(OH)D but negatively associated with cord 25(OH)D.

Conclusions: Prenatal maternal and cord blood 25(OH)D levels are associated with the early life gut microbiota. Future studies are needed to understand how vitamin D and the microbiome may interact to influence child health.
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http://dx.doi.org/10.1186/s40748-020-00119-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7576815PMC
October 2020

The indirect impact of COVID-19 on child health.

Paediatr Child Health (Oxford) 2020 Dec 16;30(12):430-437. Epub 2020 Sep 16.

F1, Royal Derby Hospital, UK. Conflicts of interest: none declared.

Since the detection of COVID-19 in December 2019, the rapid spread of the disease worldwide has led to a new pandemic, with the number of infected individuals and deaths rising daily. Early experience shows that it predominantly affects older age groups with children and young adults being generally more resilient to more severe disease.1, 2, 3 From a health standpoint, children and young people are less directly affected than adults and presentation of the disease has shown different characteristics. Nonetheless, COVID-19 has had severe repercussions on children and young people. These indirect, downstream implications should not be ignored. An understanding of the issues is essential for those who hope to advocate effectively for children to prevent irreversible damage to the adults of the future. This article reviews some of the evidence of harm to children that may accrue indirectly as a result of pandemics. It explores the physical and psychological effects, discusses the role of parenting and education, offering practical advice about how best to provide support as a healthcare professional.
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http://dx.doi.org/10.1016/j.paed.2020.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7494255PMC
December 2020

Human Milk From Atopic Mothers Has Lower Levels of Short Chain Fatty Acids.

Front Immunol 2020 21;11:1427. Epub 2020 Jul 21.

inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States.

Short chain fatty acids (SFCAs) are microbial metabolites produced in the gut upon fermentation of dietary fiber. These metabolites interact with the host immune system and can elicit epigenetic effects. There is evidence to suggest that SCFAs may play a role in the developmental programming of immune disorders and obesity, though evidence in humans remains sparse. Here we have quantified human milk (HM) SCFA levels in an international cohort of atopic and non-atopic mothers ( = 109). Our results demonstrate that human milk contains detectable levels of the SCFAs acetate, butyrate, and formate. Samples from atopic mothers had significantly lower concentrations of acetate and butyrate than those of non-atopic mothers. HM SCFA levels in atopic and non-atopic women also varied based on maternal country of residence (Australia, Japan, Norway, South Africa, USA). Reduced exposure to HM SCFA in early life may program atopy or overweight risk in breastfed infants.
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http://dx.doi.org/10.3389/fimmu.2020.01427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7396598PMC
April 2021

Possibility for reverse zoonotic transmission of SARS-CoV-2 to free-ranging wildlife: A case study of bats.

PLoS Pathog 2020 09 3;16(9):e1008758. Epub 2020 Sep 3.

US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

The COVID-19 pandemic highlights the substantial public health, economic, and societal consequences of virus spillover from a wildlife reservoir. Widespread human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) also presents a new set of challenges when considering viral spillover from people to naïve wildlife and other animal populations. The establishment of new wildlife reservoirs for SARS-CoV-2 would further complicate public health control measures and could lead to wildlife health and conservation impacts. Given the likely bat origin of SARS-CoV-2 and related beta-coronaviruses (β-CoVs), free-ranging bats are a key group of concern for spillover from humans back to wildlife. Here, we review the diversity and natural host range of β-CoVs in bats and examine the risk of humans inadvertently infecting free-ranging bats with SARS-CoV-2. Our review of the global distribution and host range of β-CoV evolutionary lineages suggests that 40+ species of temperate-zone North American bats could be immunologically naïve and susceptible to infection by SARS-CoV-2. We highlight an urgent need to proactively connect the wellbeing of human and wildlife health during the current pandemic and to implement new tools to continue wildlife research while avoiding potentially severe health and conservation impacts of SARS-CoV-2 "spilling back" into free-ranging bat populations.
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http://dx.doi.org/10.1371/journal.ppat.1008758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470399PMC
September 2020

Association between cesarean delivery types and obesity in preadolescence.

Int J Obes (Lond) 2020 10 1;44(10):2023-2034. Epub 2020 Sep 1.

Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA.

Background/objectives: The association between mode of delivery and childhood obesity remains inconclusive. Because few studies have separated C-section types (planned or unplanned C-section), our objective was to assess how these subtypes relate to preadolescent obesity.

Subjects/methods: The study consisted of 570 maternal-child pairs drawn from the WHEALS birth cohort based in Detroit, Michigan. Children were followed-up at 10 years of age where a variety of anthropometric measurements were collected. Obesity was defined based on BMI percentile (≥95th percentile), as well as through Gaussian finite mixture modeling on the anthropometric measurements. Risk ratios (RRs) and 95% confidence intervals (CIs) for obesity comparing planned and unplanned C-sections to vaginal deliveries were computed, which utilized inverse probability weights to account for loss to follow-up and multiple imputation for covariate missingness. Mediation models were fit to examine the mediation role of breastfeeding.

Results: After adjusting for marital status, maternal race, prenatal tobacco smoke exposure, maternal age, maternal BMI, any hypertensive disorders during pregnancy, gestational diabetes, prenatal antibiotic use, child sex, parity, and birthweight z-score, children born via planned C-section had 1.77 times higher risk of obesity (≥95th percentile), relative to those delivered vaginally ((95% CI) = (1.16, 2.72); p = 0.009). No association was found comparing unplanned C-section to vaginal delivery (RR (95% CI) = 0.75 (0.45, 1.23); p = 0.25). The results were similar but slightly stronger when obesity was defined by anthropometric class (RR (95% CI) = 2.78 (1.47, 5.26); p = 0.002). Breastfeeding did not mediate the association between mode of delivery and obesity.

Conclusions: These findings indicate that children delivered via planned C-section-but not unplanned C-section-have a higher risk of preadolescent obesity, suggesting that partial labor or membrane rupture (typically experienced during unplanned C-section delivery) may offer protection. Additional research is needed to understand the biological mechanisms behind this effect, including whether microbiological differences fully or partially account for the association.
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http://dx.doi.org/10.1038/s41366-020-00663-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530127PMC
October 2020

Fetal and early postnatal lead exposure measured in teeth associates with infant gut microbiota.

Environ Int 2020 11 29;144:106062. Epub 2020 Aug 29.

Department of Public Health Sciences, Henry Ford Health System, Detroit, USA. Electronic address:

Background: Lead (Pb) is an environmentally ubiquitous heavy metal associated with a wide range of adverse health effects in children. Both lead exposure and the early life microbiome- which plays a critical role in human development-have been linked to similar health outcomes, but it is unclear if the adverse effects of lead are partially driven by early life gut microbiota dysbiosis. The objective of this study was to examine the association between in utero and postnatal lead levels (measured in deciduous baby teeth) and early life bacterial and fungal gut microbiota in the first year of life.

Methods: Data from the Wayne County Health, Environment, Allergy and Asthma Longitudinal Study (WHEALS) birth cohort were analyzed. Tooth lead levels during the 2nd and 3rd trimesters and postnatally (<1 year of age) were quantified using high-resolution microspatial mapping of dentin growth rings. Early life microbiota were measured in stool samples collected at approximately 1 and 6 months of age, using both 16S rRNA (bacterial) and ITS2 (fungal) sequencing. Of the 1,258 maternal-child pairs in WHEALS, 146 had data on both tooth metals and early life microbiome.

Results: In utero tooth lead levels were significantly associated with gut fungal community composition at 1-month of age, where higher levels of 2nd trimester tooth lead was associated with lower abundances of Candida and Aspergillus and higher abundances of Malassezia and Saccharomyces; 3rd trimester lead was also associated with lower abundances of Candida. Though lead did not significantly associate with the overall structure of the infant gut bacterial community, it associated with the abundance of some specific bacterial taxa, including the increased abundance of Collinsella and Bilophila and a decreased abundance of Bacteroides taxa.

Conclusions: The observed associations between lead exposure and infant gut microbiota could play a role in the impact of lead on childhood development. Given the paucity of research examining these associations in humans-particularly for fungal microbiota-further investigation is needed.
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http://dx.doi.org/10.1016/j.envint.2020.106062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572588PMC
November 2020