In ovo administration of the Marek's disease vaccine in conjunction with 25-hydroxyvitamin D3 and its subsequent effects on the performance and immunity-related characteristics of Ross 708 broiler hatchlings1,2,3.

The combined effects of the in ovo injection of commercial Marek's disease vaccine (MDV) and various levels of 25-hydroxyvitamin D3 (25OHD3) on the hatch variables, immunological measurements, and gene expression of Ross 708 hatchling broilers were investigated. A total of 5 in ovo injection treatments that were applied at 18 d of incubation (doi) included: 1) noninjected (control); or a 50 µL solution volume of 2) MDV alone; or MDV combined with 3) 0.6 µg of 25OHD3; 4) 1.2 µg of 25OHD3; or 5) 2.4 µg of 25OHD3. At hatch, hatchability of set and live embryonated eggs, hatchling body weight, hatch residue analysis, serum IgY and alpha-1 acid glycoprotein (AGP) concentrations, and the expression of genes related to immunity (INFα, INFß, INFγ, TLR-3, and TLR-21) and vitamin D3 activity (1 α-hydroxylase, 24 hydroxylase, and vitamin D receptor) were determined. No significant treatment differences were observed for hatchability of set and live embryonated eggs, or for serum IgY and AGP concentrations. However, hatchling body weight was higher when MDV was combined with either 1.2 or 2.4 µg of 25OHD3 than when MDV was provided alone or in combination with 0.6 µg of 25OHD3. Also, in comparison to the noninjected treatment group, the expression of the genes for 1 α-hydroxylase and 24 hydroxylase was improved when MDV was combined with either 1.2 or 2.4 µg of 25OHD3. Lastly, expression of the genes linked to viral detection (TLR-3) and antibody production (INF-ß) was increased in those treatments that contained any level of 25OHD3. These results indicate that in comparison to controls, the effects of MDV were observed to be greater on hatchling BW and splenic gene expression when it was administered in combination with the 1.2 or 2.4 µg doses of 25OHD3. Further research is needed to determine the posthatch effects of the administration of various levels of 25OHD3 in combination with MDV.

A retrospective audit of the timescales involved in the diagnosis and management of suspected Achilles tendon ruptures at a single National Health Service trust: A quality service improvement and redesign project.

Introduction: The Achilles tendon is the most frequently ruptured tendon. Prompt diagnosis of this injury ensures optimal management decisions are instituted early ensuring the best outcome and patient experience, at minimal cost to the United Kingdom National Health Service. Despite this, regional and national variations to diagnosis and management exist, with anecdotal evidence of inefficiencies in the local patient pathway. To explore this further, a retrospective departmental audit of timescales from presentation to ultrasound diagnosis and definitive treatment decision was undertaken. Methods: All suspected Achilles tendon ruptures in 2018 were identified through electronic and written patient records, and information on timescales involved in the diagnosis and management of each compiled. Descriptive statistics were used to map each step of the pathway and timescales involved, with performance assessed against local departmental standards and the Swansea Morriston Achilles Rupture Treatment (SMART) protocol. Results: In total, 119 patients were identified, of which 113 received an ultrasound examination. Local departmental standards were met in the majority of cases, with 78% (n = 88) diagnosed by ultrasound within one week of the request and 83% (n = 91) given a treatment decision within two weeks of presentation. However, this was suboptimal when compared with timeframes utilised for developing the SMART protocol, with only 7% (n = 8) scanned within 48 hours of presentation. Conclusions: Key areas of the patient pathway were identified for quality service improvement and redesign, with multidisciplinary discussion resulting in the development of a revised patient pathway which expedites diagnosis and treatment for these injuries.

Effects of administration of an in ovo coccidiosis vaccine at different embryonic ages on vaccine cycling and performance of broiler chickens,.

Use of a live coccidiosis vaccine has become an increasingly common method to control coccidiosis, especially in antibiotic-free broiler production. The Inovocox EM1 vaccine (EM1) is recommended for the vaccination of embryonated broiler hatching eggs between 18.0 and 19.0 d of incubation (doi). This allows for earlier acquisition of immunity to wild-type coccidia. However, it is unclear whether the difference in embryo age at the time of in ovo injection can influence the effect of the vaccine during grow-out as well as if the growth performance of broiler chickens is affected. Therefore, the objective of the study was to evaluate the effects of 2 injection ages (18.5 and 19.0 doi) and 3 injection types (noninjected, diluent, and vaccine) in a 3 × 2 factorial design, consisting of 10 replicates per treatment (60 treatment-replicate groups). There was a significant effect of injection age on BW at 0, 14, and 35 d after hatch, with a difference in the BW of birds belonging to the 18.5 and 19.0 doi groups up to day 35 after hatch. There was a significant effect of injection type on BW gain, feed intake, and FCR between 0 and 28 d after hatch. Between 0 and 35 d, FCR was lower in the vaccine-injected group in comparison with the noninjected and diluent control groups. Furthermore, total intestine coccidia and lesion indices were higher in the vaccine-18.5 treatment group in comparison with the diluent-18.5 treatment group at 28 d. In conclusion, hatchling weight was affected by injection age, and this subsequently affected growth performance. Furthermore, intestinal coccidia cycling peaked at 28 d, resulting in a reduction in growth performance through 28 d and subsequent compensatory growth by 35 d. There was no significant difference in coccidiosis cycling between the vaccine-18.5 and vaccine-19.0 doi treatment combination groups.

Effects of stage of broiler embryo development on coccidiosis vaccine injection accuracy, and subsequent oocyst localization and hatchling quality.

Control of coccidiosis in broiler chickens continues to pose challenges to commercial poultry producers, especially in an era of increased consumer demand for antibiotic-free broiler production. As a result, coccidiosis vaccines are now commonly used in rotation programs to achieve effective coccidiosis control. Inovocox EM1 vaccine (EM1) is a coccidiosis vaccine that allows for earlier immune acquisition through oocyst cycling, which reduces the effects of wild-type coccidia. The EM1 vaccine is administered to embryonated broiler hatching eggs between 18 and 19 D of incubation (doi). In the U.S., commercial broiler hatcheries vaccinate embryonated eggs at either 18.5 or 19 doi. However, it is unclear whether a difference in embryo age at the time of in ovo injection can impact the actual site of vaccine delivery. In addition, it is unclear where oocysts eventually become localized within the embryo following the in ovo injection of EM1. Therefore, the objective of this study was to determine the effects of stage of embryonic development on the actual deposition site of the EM1 vaccine oocysts when they are in ovo injected and to subsequently investigate the movement and eventual location of EM1 oocysts after in ovo injection. Because all eggs were injected at the same time, a 12-h difference in set time was a means to derive 18.5 and 19.0 incubation age of injection (IAN) treatments. The experimental design was a 3 injection treatment (noninjected, diluent-injected, and vaccine-injected) × 2 IAN factorial. There was a significant main effect of IAN on site of vaccine oocysts delivery, and subsequent hatching chick quality. Qualitative histological evaluation revealed the oral uptake of vaccine oocysts through the amnion, with their subsequent presence in the gizzard and intestinal lumen by 24 to 36 h postinjection. In conclusion, physiological development influenced the site of injection, and oocysts imbibed along with the amniotic fluid in late stage broiler embryos are subsequently transported to the gastrointestinal tract.

Eliciting the impacts of cellular noise on metabolic trade-offs by quantitative mass imaging.

Optimal metabolic trade-offs between growth and productivity are key constraints in strain optimization by metabolic engineering; however, how cellular noise impacts these trade-offs and drives the emergence of subpopulations with distinct resource allocation strategies, remains largely unknown. Here, we introduce a single-cell strategy for quantifying the trade-offs between triacylglycerol production and growth in the oleaginous microorganism Yarrowia lipolytica. The strategy relies on high-throughput quantitative-phase imaging and, enabled by nanoscale secondary ion mass spectrometry analyses and dedicated image processing, allows us to image how resources are partitioned between growth and productivity. Enhanced precision over population-averaging biotechnologies and conventional microscopy demonstrates how cellular noise impacts growth and productivity differently. As such, subpopulations with distinct metabolic trade-offs emerge, with notable impacts on strain performance and robustness. By quantifying the self-degradation of cytosolic macromolecules under nutrient-limiting conditions, we discover the cell-to-cell heterogeneity in protein and fatty-acid recycling, unmasking a potential bet-hedging strategy under starvation.

Comparative effects of in ovo versus subcutaneous administration of the Marek's disease vaccine and pre-placement holding time on the intestinal villus to crypt ratios of Ross 708 broilers during early post-hatch development1,2,3.

Villus to crypt ratio (VCR) is used to quantify the microanatomical response of the intestine to various treatments. In early age chickens, comparative effects of the in ovo (i.o.) and s.c. methods of administration (moa) of the Marek's disease (MD) vaccine on 2 types of measurement of small intestinal VCR at 0 and 4 h post-hatch (poh) were investigated. The effects of moa and 4 and 18 h pre-placement holding times (pht) on the VCR measurements at 168 h (7 d) poh were also investigated. In the jejunum of the small intestine, a standard method for VCR determination, based on 10 villus and crypt length measurements, was utilized for the calculation of villus to crypt length ratio (VCLR). In that same region, a single histomorphometric determination of the crypt and total mucosa areas using image analysis software was also used. Subtraction of the crypt area from the total mucosa area provided the villus area, allowing for calculation of the villus to crypt area ratio (VCAR). Across 0, 4, and 18 h of poh bird age, the VCLR of birds that received an s.c. vaccination was higher in comparison to that of those that received an i.o. vaccination. The highest and lowest VCAR values were observed in the s.c. treatment at 0 h poh and in the i.o. treatment at 4 h poh, respectively. Furthermore, at 168 h poh, VCLR values in the 18 h pht and s.c. vaccination group were higher than those in the 4 h pht and s.c. vaccination or 18 h and i.o. vaccination groups. In conclusion, the effects of pht and MD vaccine moa on VCR were dependent on the use of either the VCLR or VCAR method of measurement. However, regardless of method, s.c. injection overall led to a higher VCR through 4 h poh in Ross 708 broilers, and the effects of moa on VCLR at 168 h were influenced by pht.

Mutations in osteoprotegerin account for the CCAL1 locus in calcium pyrophosphate deposition disease.

OBJECTIVE: Mutations on chromosomes 5p (CCAL2) and 8q (CCAL1) have been linked to familial forms of calcium pyrophosphate deposition disease (CPDD). Mutations in the ANKH gene account for CCAL2, but the identity of CCAL1 has been elusive. Recently, a single Dutch kindred with a mutation in the Tumor Necrosis Factor Receptor Super Family member 11B (TNFRSF11B) gene coding for osteoprotegerin (OPG) was described as a gain-of-function mutation. Affected family members had premature generalized osteoarthritis (PGOA) and CPDD. As the TNFRSF11B gene is on 8q, we sought additional evidence that TNFRSF11B was CCAL1, and investigated potential disease mechanisms. DESIGN: DNA from two novel PGOA/CPDD families was screened for sequence variants in the TNFRSF11B gene. Mutations were verified by genotype analysis of affected and unaffected family members. We also investigated effects of normal and mutant OPG on regulators of CPP crystal formation in porcine cartilage. RESULTS: The identical TNFRSF11B mutation described in the Dutch family was present in two novel PGOA/CPDD families. ANKH was normal in affected patient fibroblasts. Exogenous OPG did not alter ANKH mRNA or protein levels, affect translocation of ANKH to the membrane, nor increase [pyrophosphate (PPi)] or other key regulators of CPDD. CONCLUSION: We have firmly established the identity of CCAL1 as TNFRSF11B (OPG). Our findings suggest that this mutation produces disease in an ANKH-independent manner via novel mechanisms not primarily targeting cartilage. This work rationalizes further investigation of OPG pathway components as potential druggable targets for CPDD.

Effects of in ovo injection of different doses of coccidiosis vaccine and turn-out times on broiler performance,.

Inovocox EM1 vaccine (EM1) is hatchery-applied via in ovo injection for the control of coccidiosis in broiler chickens. Effects of 3 in ovo injection treatments (INT) and 2 turn-out times (TOT) on the hatching chick quality variables and 35 d posthatch performance of Ross × Ross 708 broilers were investigated. In a single-stage incubator, 1,440 hatching eggs were randomly distributed among 3 INT groups on each of 8 tray levels. At 19 d of incubation (doi), embryonated eggs were subjected to one of the following INT by in ovo injection: noninjected control; 1 × dose of EM1; 10 × dose of EM1. On 21 doi, hatchability of injected eggs (HI), hatching body weight (HBW), and hatching chick quality variables were determined. Additionally, for the grow-out phase, birds belonging to each INT were randomly subjected to a 7 or 10 d TOT. Twenty chicks were initially placed in each of 48 floor pens (6 INT × TOT combination groups × 8 replications) for growth performance evaluation from 0 to 35 d posthatch. The main effect of INT on hatching chick quality variables, as well as the main and interactive effects of INT and TOT on various grow-out performance variables were determined. Although there was no significant INT effect on HI or HBW, significant INT effects on chick total BW, yolk-free BW, and yolk sac weight were observed. There were significant INT effects on BWG and FCR in the 21- to 28-d posthatch interval, as well as on BWG and FCR in the 0- to 35-d posthatch interval. There was no main effect of TOT or interactive effect of INT and TOT on BW and other performance variables from 0 to 35 d posthatch. There was a significant main effect of INT on relative intestine weight at 28 d posthatch. In conclusion, the injection of EM1 vaccine at a 10 × dose may affect hatching chick quality variables and growth performance up to 35 d posthatch.

Capacity to report on mortality attributable to chronic hepatitis B and C infections by Member States: An exercise to monitor progress towards viral hepatitis elimination.

Viral hepatitis is globally leading causes of death, and 96% of these are due to hepatitis B and C (HBV/HCV) late outcomes. The first Global Health Sector Strategy (GHSS) aims to reduce by 65% the mortality associated with HBV/HCV, and an indicator (C10) is proposed to monitor progress. Data on viral hepatitis and liver-related mortality are required, and different methods of estimation can be used, depending on availability and quality of sources. We aimed to understand the current situation and practicality of calculating C10, accessing available sources to estimate initial figure for Europe. We listed and compiled regional and national data sources reporting deaths from HCC, cirrhosis and chronic liver disease (CLD) and available estimates of attributable fraction. We critically appraised quality of data, highlighting gaps in current data and estimated mortality attributable to HBV and HCV, for 31 EU/EEA countries from 2010 to 2015. Mortality data are available for 30/31 countries. Quality varies but 60% of national sources report with specificity as required by WHO indicator. Attributable fraction is only available through the literature search. We estimated C10 for 87.6% country-years. Deaths attributable to HBV/HCV for this period and region were 292 600, while HCV deaths were three times higher. Incomplete data for 2015 prevented calculation of time trends. Regional sources are outdated for monitoring C10, but national sources are capable of reporting mortality data. Sources for attributable fraction are sparse, outdated and much needed. We recommend improvement of death registration allowing measuring this indicator. Studies measuring attributable fraction on national and subnational levels are crucial.

Comparison of two methods for determination of intestinal villus to crypt ratios and documentation of early age-associated ratio changes in broiler chickens,.

The determination of intestinal villus to crypt ratios (VCR) is a common method utilized to evaluate effects of various diet regimens on gut microanatomy and for the histologic quantification of intestinal responses to disease processes. Two methods for the determination of small intestinal VCR were compared in early age chickens. A standard method for VCR determination based on 10 villus and crypt length measurements in the jejunal region of the small intestine was employed for the calculation of villus to crypt length ratio (VCLR). That method was compared to a new approach based on a single histomorphometric determination of the crypt and total mucosal areas using image analysis software. Subtraction of the crypt area from the total area provided the villus area and allowed for the subsequent calculation of villus to crypt area ratio (VCAR). At 4 and 18 h posthatch, VCLR was higher than that of VCAR, but there was no significant difference between VCLR and VCAR at 0 h (hatch) and at 168 h (d 7) posthatch. Nevertheless, the pattern of age-associated changes for VCLR and VCAR were comparable throughout the early posthatch period. Furthermore, the new method used in determining VCAR is subject to less human error, allows for an appreciable reduction in the number of measurements required, and facilitates a larger intestinal segment evaluation. Standard linear measurements require the selection of variable numbers of villi and crypts, whereas the area method only requires selection of a single region that incorporates numerous villi and crypts of variable sizes in providing a less subjective approach. This is particularly advantageous in studies on intestinal disease conditions resulting in marked multifocal variation in villus stature. This study further documented age-associated changes occurring in the VCR of the small intestine during the early posthatch period. Across the 2 methods used for VCR determination, a major and highly significant reduction in the VCR was observed to occur between 18 h and 168 h posthatch.

Strategies to improve beef tenderness by activating calpain-2 earlier postmortem.

Our objectives were to determine the effect of post rigor calcium chloride injection or freezing on 1) sarcoplasmic calcium concentration and calpain-2 activity of beef longissimus lumborum (LL) and semimembranosus (SM) steaks aged 1, 4, and 14days post-treatment and on 2) Warner-Bratzler shear force, water holding capacity, and consumer acceptability of LL and SM steaks aged 4 and 14days post-treatment. Free calcium levels in the calcium, frozen, and control steaks averaged 1256, 127, and 121µM for the LL and 1520, 120, and 111µM for the SM, respectively. Measurable LL native calpain-2 activity was lower in calcium and frozen steaks than control steaks (P<0.01), while SM native calpain-2 activity was lowest in calcium steaks and intermediate in frozen steaks (P<0.01). LL calcium steaks were more tender (P=0.04) than control steaks. In conclusion, calcium chloride injection and freezing activate calpain-2 earlier postmortem in both muscles and calcium injection improves LL tenderness.

Effects of coccidiosis vaccination administered by in ovo injection on Ross 708 broiler performance through 14 days of post-hatch age.

Effects of the in ovo injection of a commercial coccidiosis vaccine on various hatching chick quality variables and 14 d post-hatch (dph) oocyst shedding have been previously examined. The current study was designed to examine the performance of Ross 708 broilers during the 14 dph period of oocyst shedding following the application of the coccidiosis vaccine. On each of 7 replicate tray levels of a single-stage incubator, a total of 4 treatment groups was randomly represented, with each treatment group containing 63 eggs. Treatments were administered using a commercial multi-egg injector on d 18.5 of incubation. The treatments included 3 control groups (non-injected, dry-punch, and diluent-injected) and one treatment group (injected with diluent containing Inovocox EM1 vaccine). On d 21 of incubation, 20 chicks from each of the 28 treatment-replicate groups were placed in corresponding wire-floored battery cages. Mortality, feed intake (FI), BW gain (BWG), and feed conversion ratio (FCR) were determined for the zero to 7, 7 to 14, and cumulative zero to 14 dph intervals. There were no significant treatment effects on mortality in any interval or on BW at zero dph. There were significant treatment effects on BW at 7 and 14 dph, on BWG and FI in the zero to 7, 7 to 14, and zero to 14 dph intervals, and on FCR in the 7 to 14 and zero to 14 dph intervals. Although the performance variables of birds belonging to the diluent-injected and vaccine-injected groups were not significantly different, the 14 dph BW, 7 to 14 dph FI, and zero to 14 dph BWG and FI of birds belonging to the vaccine treatment group were significantly higher than those in birds belonging to the non-injected control group. It was concluded that use of the Inovocox EM1 vaccine in commercial diluent has no detrimental effect on the overall post-hatch performance of broilers through 14 dph.

The relationship between different information sources and disease-related patient knowledge and anxiety in patients with inflammatory bowel disease.

BACKGROUND: Patient education forms a cornerstone of management of inflammatory bowel disease (IBD). The Internet has opened new avenues for information gathering. AIM: To determine the relationship between different information sources and patient knowledge and anxiety in patients with IBD. METHODS: The use of information sources in patients with IBD was examined via questionnaire. Anxiety was assessed with the hospital anxiety and depression scale and disease-related patient knowledge with the Crohn's and colitis knowledge score questionnaires. Associations between these outcomes and demographics, disease-related factors, and use of different information sources were analysed using linear regression analysis. RESULTS: Of 307 patients (165 Crohn's disease, 142 ulcerative colitis) 60.6% were female. Participants used the hospital IBD team (82.3%), official leaflets (59.5%), and official websites (53.5%) most frequently in contrast to alternative health websites (9%). University education (P < 0.001), use of immunosuppressants (P = 0.025), Crohn's and Colitis UK membership (P = 0.001), frequent use of the hospital IBD team (P = 0.032), and frequent use of official information websites (P = 0.005) were associated with higher disease-related patient knowledge. Female sex (P = 0.004), clinically active disease (P < 0.001), frequent use of general practitioners (P = 0.014), alternative health websites (homoeopathy, nutritionists, etc.) (P = 0.004) and random links (P = 0.016) were independently associated with higher anxiety. CONCLUSIONS: Different patient information sources are associated with better knowledge or worse anxiety levels. Face-to-face education and written information materials remain the first line of patient education. Patients should be guided towards official information websites and warned about the association between the use of alternative health websites or random links and anxiety.

Effects of coccidiosis vaccination administered by in ovo injection on the hatchability and hatching chick quality of broilers1,2,3.

Effects of the in ovo injection of a commercial coccidiosis vaccine on the hatchability and hatching chick quality variables of Ross × Ross 708 broilers were examined. Four treatment (TRT) groups were represented on each of 7 replicate tray levels of a single-stage incubator (28 TRT-replicate groups). Each TRT-replicate contained 63 eggs (1,764 total eggs). On d 18.5 of incubation, eggs were subjected to one of 4 TRT using a commercial multi-egg injector. Three control groups (non-injected, dry-punch, and diluent-injected) and one TRT group (injected with diluent containing Inovocox EM1 vaccine) were used. On d 18.5 of incubation, the site of injection and stage of embryo development were determined. On d 21.5 of incubation (d zero post hatch), hatchability of injected eggs (HI), chick BW, and yolk sac, intestine, and liver weights were determined. On d zero post hatch, 20 chicks from each of the 28 TRT-replicate groups (560 total birds) were placed in corresponding isolated wire-floored battery cages. On a daily basis, from d zero to 14 post hatch, pooled fecal samples from each individual replicate cage were collected for oocyst output determination. There was no significant difference among TRT for HI or chick BW on d 21.5 of incubation. In the non-injected control and vaccine-treated groups, mean HI was 93.1 and 89.4%, respectively, and chick BW were 43.4 and 43.8 g, respectively. The mean embryonic stage score was 2.09, and 84.8 and 15.3% of in ovo injections were in the amnion and embryo, respectively. Oocyst shedding began 4 d post hatch (d 6 post injection), and reached a peak at d 7 post hatch (d 10 post injection). It was concluded that the in ovo injection of Inovocox EM1 vaccine did not have a significant detrimental effect on broiler embryogenesis or hatching chick quality.

Midwives and women's views on using UK recommended depression case finding questions in antenatal care.

OBJECTIVE: detecting and treating depression early on in pregnancy can improve health outcomes for women and their children. UK guidelines recommend that Midwives screen for antenatal depression (AND) at the woman's first Midwife appointment using recommended depression case finding questions. This is the first qualitative study to explore Midwives' and women's views of using these questions in the context of antenatal care. DESIGN: Semi-structured interviews with Midwives and pregnant women exploring their views and experiences of screening for AND, conducted alongside a validation study of the depression case finding questions. SETTING: the initial appointment with the Midwife when the woman is 10-12 weeks pregnant. Interviewees were working or living in Bristol, England. PARTICIPANTS: maximum variation samples of 15 Midwives and 20 pregnant women. MEASUREMENTS AND FINDINGS: Midwives and pregnant women viewed the depression case finding questions as a useful way of introducing mental health issues. Midwives often adapted the questions rather than using the phrasing specified in the UK guideline. Sometimes Midwives chose not to use the questions, for example if a partner was present. Both Midwives and women struggled to differentiate symptoms of early pregnancy from antenatal depression; yet thought that detecting depression early on in pregnancy was important. Women were unsure about the kind of help that was available; some women reported this as a reason for withholding their true feelings. There was a general lack of awareness among Midwives about the range of non-drug treatments potentially available to women and referral pathways to access them. KEY CONCLUSION: both Midwives and women regard screening for AND as acceptable and important but reported shortcomings with the recommended depression case finding questions. IMPLICATIONS FOR PRACTICE: providing training for Midwives on how to frame the questions and increase their knowledge and application of the referral pathways suggested by UK guidelines will help address some of the issues raised by Midwives and women in our study.

Hormonal contraceptive use before and after conception in relation to preterm birth and small for gestational age: an observational cohort study.

OBJECTIVE: To evaluate whether hormonal contraceptives, used before or in early pregnancy, confer increased risk of preterm birth or reduced fetal growth. DESIGN: Population-based cohort study conducted by the Norwegian Institute of Public Health (Mother and Child Cohort Study, 1998-2008) with linkage to the Norwegian Prescription Registry and to the Medical Birth Registry of Norway. SETTING: Norway. POPULATION: Of the 48,615 pregnancies meeting study inclusion criteria, 44,734 pregnancies were included in the complete case analysis. METHODS: We characterised hormonal contraception by type (combination oral, progestin-only oral, vaginal ring, transdermal, and injectable) and specific progestin component. We used generalised estimating equations to estimate the odds of adverse outcome according to formulation used. Several sensitivity analyses were conducted. MAIN OUTCOME MEASURES: Preterm birth, small for gestational age. RESULTS: We observed a positive association between use of a combination oral contraceptive and preterm birth for all exposure periods (e.g. adjusted odds ratio 1.21, 95% confidence interval 1.04-1.41 for last use 12 to >4 months before conception); combination contraceptives containing the progestin norethisterone were consistently related to risk. Other types of hormonal contraception were generally not associated with preterm birth; none were related to small for gestational age. Observed associations were robust to sensitivity analyses. CONCLUSION: Hormonally active agents may exert dose-, agent-, and timing-specific effects on growth and development. We found that the particular progestin component is important when assessing the potential for adverse effects among former users of hormonal contraceptives.

Time, place, and people: composition of the EPIET Alumni Network and its contribution to the European public health resource in 2013.

The EPIET Alumni Network (EAN) is an association of professionals who have completed field epidemiology or public health microbiology training programmes in the European Union. In 2013, we conducted a survey of EAN members to investigate this network's role within European public health. We distributed an online questionnaire to members registered at the time, collecting data on demographics, professional background, and attitudes towards EAN. Out of 362 registered members, 189 (52%) responded; 97% were from Europe; 65% were female. Their mean age was 39 years. The highest academic qualification was PhD for 44% and Master's degree for 55%. The majority (60%) worked in public health institutes. They were especially satisfied with having access to job offers and professional networking via EAN, but requested more learning opportunities and knowledge-sharing between members. EAN is a unique platform where highly skilled professionals can connect to control infectious diseases locally and internationally. Having a network of professionals that know each other, speak the same 'language', and can easily access each other's expertise, represents an important resource for European and global public health, which should be nurtured by encouraging more collaborations devoted to professional development.

Maternal hormonal contraceptive use and offspring overweight or obesity.

BACKGROUND/OBJECTIVES: Experiments in animal models have shown a positive association between in utero exposure to pharmacologic sex hormones and offspring obesity. The developmental effects of such hormones on human obesity are unknown. SUBJECTS/METHODS: Using data from a large, prospective pregnancy cohort study (n=19 652), with linkage to a national prescription registry, we evaluated the association between use of hormonal contraceptives before and after conception (defined from dispensed prescription data and characterized by last date of use relative to conception, 12 to >4 months before (n=3392), 4 to >1 months before (n=2541), 1 to >0 months before (n=2997) and 0-12 weeks after (n=567)) in relation to offspring overweight or obesity at age 3 years. RESULTS: We observed a weak, inverse association between early pregnancy use of a combination oral contraceptive and offspring overweight or obesity at age 3 (adjusted odds ratio (OR): 0.75, 95% confidence interval (CI): 0.53, 1.08) and a positive, but imprecise, association with use of a progestin-only oral contraceptive in early pregnancy (adjusted OR: 1.26, 95% CI: 0.79, 2.02). In general, no association was observed between the use of a hormonal contraceptive before conception and offspring overweight or obesity. A sensitivity analysis comparing combination oral contraceptive users in early pregnancy to other unplanned pregnancies without hormonal contraceptive use further strengthened the inverse association (adjusted OR: 0.70, 95% CI: 0.48, 1.02). Other sensitivity analyses were conducted to evaluate the robustness of the associations observed given varying assumptions. CONCLUSIONS: Pharmacologic sex hormones in early pregnancy may be inversely or positively associated with offspring overweight or obesity at age 3, depending on the specific formulation used. The present study provides support for the potential for environmental sources of hormonally active agents to exert developmental effects.

Recent outbreaks of infectious syphilis, United Kingdom, January 2012 to April 2014.

Six outbreaks of infectious syphilis in the United Kingdom, ongoing since 2012, have been investigated among men who have sex with men (MSM) and heterosexual men and women aged under 25 years. Interventions included case finding and raising awareness among healthcare professionals and the public. Targeting at-risk populations was complicated as many sexual encounters involved anonymous partners. Outbreaks among MSM were influenced by the use of geospatial real-time networking applications that allow users to locate other MSM within close proximity.