Ecology and evolution of antibiotic persistence.

Bacteria have at their disposal a battery of strategies to withstand antibiotic stress. Among these, resistance is a well-known mechanism, yet bacteria can also survive antibiotic attack by adopting a tolerant phenotype. In the case of persistence, only a small fraction within an isogenic population switches to this antibiotic-tolerant state. Persistence depends on the ecological niche and the genetic background of the strains involved. Furthermore, it has been shown to be under direct and indirect evolutionary pressure. Persister cells play a role in chronic infections and the development of resistance, and therefore a better understanding of this phenotype could contribute to the development of effective antibacterial therapies. In the current review, we discuss how ecological and evolutionary forces shape persistence.

Maternal avoidance, anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period.

BACKGROUND: Few studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy. AIMS: This longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development. STUDY DESIGN: Subjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age. SUBJECTS: n = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant. OUTCOME MEASURES: Infant performance on Bayley-III language and cognitive scales. RESULTS: Infants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of "maternal avoidance accompanied" in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance. CONCLUSIONS: Results underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.

Anxious women do not show the expected decrease in cardiovascular stress responsiveness as pregnancy advances.

Altered stress responsiveness is a risk factor for mental and physical illness. In non-pregnant populations, it is well-known that anxiety can alter the physiological regulation of stress reactivity. Characterization of corresponding risks for pregnant women and their offspring requires greater understanding of how stress reactivity and recovery are influenced by pregnancy and women's anxiety feelings. In the current study, women were presented repeatedly with mental arithmetic stress tasks in the first and third pregnancy trimester and reported their trait anxiety using the state trait anxiety inventory. Cardiovascular stress reactivity in late pregnancy was lower than reactivity in the first pregnancy trimester (heart rate (HR): t(197)=4.98, p<.001; high frequency heart rate variability (HF HRV): t(196)=-2.09, p=.04). Less attenuation of stress reactivity occurred in more anxious women (HR: b=0.15, SE=0.06, p=.008; HF HRV: b=-10.97, SE=4.79, p=.02). The study design did not allow the influence of habituation to repeated stress task exposure to be assessed separately from the influence of pregnancy progression. Although this is a limitation, the clear differences between anxious and non-anxious pregnant women are important, regardless of the extent to which differing habituation between the groups is responsible. Less dampened stress reactivity through pregnancy may pose long-term risks for anxious women and their offspring. Follow-up studies are required to determine these risks.

IMF-screws or arch bars as conservative treatment for mandibular condyle fractures: Quality of life aspects.

OBJECTIVE: Arch bars as treatment for a fractured mandibular condyle are inconvenient to patients and lead to lowered quality of life (QOL). To overcome these inconveniences, IMF-screws (IMFS) to facilitate intermaxillary fixation during surgery have been developed. The purpose of the present study is to investigate and compare QOL for patients treated for a fractured mandibular condyle with either IMFS or arch bars. MATERIAL AND METHODS: This research trial was conducted from 2010 to 2014 as part of an earlier prospective, multicenter, randomized clinical trial in which the use of IMFS was compared to the use of arch bars in the treatment of mandibular condylar fractures. RESULTS: In total, 50 patients were included: 30 (60%) male patients and 20 (40%) female patients (mean age: 31.8 years, standard deviation [SD] = 13.9 years, range = 18-64 years). A total of 24 (48%) patients were allocated in the IMFS group, and 26 (52%) patients were assigned to the arch-bars control group. Significant results were observed in the subscales social isolation, possibility to eat and vary diet, influence on sleep, and satisfaction with the given treatment, all in favour of IMFS. CONCLUSION: In conclusion, using IMFS as a method for conservative treatment of condylar fractures led to a higher QOL during the 6-week period of fracture healing. In comparison to arch bars, patients treated with IMFS experienced less social isolation, had fewer problems with eating, and express the feeling they are able to continue their normal diet. Furthermore it seems that the use of IMFS has a lower negative impact on social and financial aspects of the patient.

Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial.

INTRODUCTION: A mandibular condyle fracture can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation (ORIF). Many IMF-modalities can be chosen, including IMF-screws (IMFS). This prospective multi-centre randomised clinical trial compared the use of IMFS with the use of arch bars in the treatment of mandibular condyle fractures. RESULTS: The study population consisted of 50 patients (mean age: 31.8 years). Twenty-four (48%) patients were allocated in the IMFS group. Twenty-six (52%) patients were assigned to the arch bars group. In total 188 IMF-screws were used (5-12 screws per patient, mean 7.83 screws per patient). All pain scores were lower in the IMFS group. Three patients developed a malocclusion (IFMS-group: one patient, arch bars-group: two patients). Mean surgical time was significantly shorter in the IMFS group (59 vs. 126 min; p<0.001). There were no needlestick injuries (0%) in the IMFS group and eight (30.7%) in the arch bars group (p=0.003). One IMF-screw fractured on insertion (0.53%), one (0.53%) screw was inserted into a root. Six (3.2%) screws loosened spontaneously in four patients. Mucosal disturbances were seen in 22 patients, equally divided over both groups. CONCLUSION: Considering the advantages and the disadvantages of IMFS, and observing the results of this study, the authors conclude that IMFS provide a superior method for IMF. IMFS are safer for the patients and surgeons.

Multimodal processing of emotional information in 9-month-old infants I: emotional faces and voices.

Making sense of emotions manifesting in human voice is an important social skill which is influenced by emotions in other modalities, such as that of the corresponding face. Although processing emotional information from voices and faces simultaneously has been studied in adults, little is known about the neural mechanisms underlying the development of this ability in infancy. Here we investigated multimodal processing of fearful and happy face/voice pairs using event-related potential (ERP) measures in a group of 84 9-month-olds. Infants were presented with emotional vocalisations (fearful/happy) preceded by the same or a different facial expression (fearful/happy). The ERP data revealed that the processing of emotional information appearing in human voice was modulated by the emotional expression appearing on the corresponding face: Infants responded with larger auditory ERPs after fearful compared to happy facial primes. This finding suggests that infants dedicate more processing capacities to potentially threatening than to non-threatening stimuli.

Multimodal processing of emotional information in 9-month-old infants II: prenatal exposure to maternal anxiety.

The ability to read emotional expressions from human face and voice is an important skill in our day-to-day interactions with others. How this ability develops may be influenced by atypical experiences early in life. Here, we investigated multimodal processing of fearful and happy face/voice pairs in 9-month-olds prenatally exposed to maternal anxiety, using event-related potentials (ERPs). Infants were presented with emotional vocalisations (happy/fearful) preceded by emotional facial expressions (happy/fearful). The results revealed larger P350 amplitudes in response to fearful vocalisations when infants had been exposed to higher levels of anxiety, regardless of the type of visual prime, which may indicate increased attention to fearful vocalisations. A trend for a positive association between P150 amplitudes and maternal anxiety scores during pregnancy may suggest these infants are more easily aroused by and extract features more thoroughly from fearful vocalisations as well. These findings are compatible with the hypothesis that prenatal exposure to maternal anxiety is related to more extensive processing of fear-related stimuli.

Maternal mindfulness during pregnancy and infant socio-emotional development and temperament: the mediating role of maternal anxiety.

BACKGROUND: Accumulating evidence shows that maternal anxiety during pregnancy adversely affects child outcomes. The positive effects of maternal psychosocial factors during pregnancy on child outcomes are not yet studied. This prospective study addresses the association between maternal mindfulness during pregnancy and socio-emotional development and temperament in 10months-old infants. We also investigated whether this association was mediated by maternal anxiety. METHOD: Mothers (N=90) provided information about mindfulness and anxiety at the beginning of the second trimester of pregnancy. Infant socio-emotional development (Ages and Stages Questionnaire: Social Emotional; ASQ:SE) and temperament (Infant Behaviour Questionnaire-Revised; IBQ-R) were assessed at age 10months. RESULTS: Higher maternal mindfulness during pregnancy was associated with less infant self-regulation problems and less infant negative affectivity. Mediation analysis showed that maternal anxiety mediated the association between infant self-regulation problems and maternal mindfulness. CONCLUSION: These results suggest that maternal mindfulness during pregnancy may have positive effects on infant development. This association may be mediated by reduced anxiety symptoms in pregnant women who score high on mindfulness. Additional replication studies are needed using objective measures of infant behavioural/emotional outcomes and mindfulness of the mother during child development.

Obesity and pregnancy, an epidemiological and intervention study from a psychosocial perspective.

BACKGROUND: Maternal obesity is a growing public health concern in Belgium as well as in other European countries and is now becoming the most common risk factor associated with pregnancy complications with impact on the health of the women and her offspring. At this moment, there is no specific management strategy for obese pregnant women and mothers, focusing on physical health and psychological well-being. OBJECTIVES: We aimed (1) to study the influence of socio-demographic and obstetrical correlates on pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) in different regions of Flanders, Belgium, (2) to review the literature on the onset and progression of labour in normal weight and obese pregnant women, (3) to compare levels and evolution of anxiety and depressed mood during pregnancy between obese women and normal-weight women, (4) to examine whether a prenatal lifestyle intervention programme, based on principles of motivational interviewing, in obese pregnant women reduces GWG and lowers levels of anxiety and depressed mood during pregnancy, (5) to examine associations between inter-pregnancy weight change from the first to the second pregnancy and the risk for adverse perinatal outcomes during the second pregnancy and finally (6) to study predictors of postpartum weight retention (PPWR) in obese mothers at six months after delivery in order to provide clues for the design of interventions aimed at preventing weight retention related to childbearing. METHODS: We performed an epidemiological study, an intervention study during pregnancy with postpartum follow up and a literature review. RESULTS: One in three Flemish women start pregnancy being overweight or obese and this prevalence has slowly been rising since 2009 in the Flanders. We identified women at risk for a high pre-pregnancy BMI and excessive GWG, both being important predictors for increased pregnancy and birth related complications. In a literature review, we showed that the combination of a higher incidence of post-term deliveries and increased inadequate contraction pattern during the first stage of labour in obese women suggests an influence of obesity on myometrial activity. Given the low compliance for adequate GWG in obese women in the general Flemish population and their increased psycho-social vulnerability compar-ed to the normal weight pregnant women, counselling obese pregnant women can lead to a reduced GWG and increased psychological comfort. Stabilizing inter-pregnancy maternal weight for all women is an important target for reducing adverse perinatal outcomes in the subsequent pregnancy. Psychological discomfort during pregnancy does impact on PPWR in obese mothers six months after delivery. DISCUSSION AND CONCLUSION: Focusing on weight management in obese women before, during and after a pregnancy has advantages for both the mother and her infant. Theoretical and practice based training modules should be developed and focus on: (1) awareness of techniques for identifying the clearly identified risk groups with a high pre-pregnancy BMI and excessive GWG, (2) the increased perinatal risks, (3) an adapted perinatal management and (4) counselling techniques for an adequate weight management and psychological wellbeing in obese pregnant women. To achieve better care for the future, we must focus on tackling maternal obesity. This means that obese women should be reached before they get pregnant for the first time. Targeting primary and community based care, promotion and education are challenging, but the psychosocial context should be acknowledged.

Detecting violations of temporal regularities in waking and sleeping two-month-old infants.

Correctly processing rapid sequences of sounds is essential for developmental milestones, such as language acquisition. We investigated the sensitivity of two-month-old infants to violations of a temporal regularity, by recording event-related brain potentials (ERPs) in an auditory oddball paradigm from 36 waking and 40 sleeping infants. Standard tones were presented at a regular 300 ms inter-stimulus interval (ISI). One deviant, otherwise identical to the standard, was preceded by a 100 ms ISI. Two other deviants, presented with the standard ISI, differed from the standard in their spectral makeup. We found significant differences between ERP responses elicited by the standard and each of the deviant sounds. The results suggest that the ability to extract both temporal and spectral regularities from a sound sequence is already functional within the first few months of life. The scalp distribution of all three deviant-stimulus responses was influenced by the infants' state of alertness.

Effects of lifestyle intervention in obese pregnant women on gestational weight gain and mental health: a randomized controlled trial.

OBJECTIVE: Lifestyle intervention could help obese pregnant women to limit their weight gain during pregnancy and improve their psychological comfort, but has not yet been evaluated in randomized controlled trials. We evaluated whether a targeted antenatal lifestyle intervention programme for obese pregnant women influences gestational weight gain (GWG) and levels of anxiety or depressed mood. DESIGN AND SUBJECTS: This study used a longitudinal interventional design. Of the 235 eligible obese pregnant women, 205 (mean age (years): 29±4.5; body mass index (BMI, kg m(-)(2)): 34.7±4.6) were randomized to a control group, a brochure group receiving written information on healthy lifestyle and an experimental group receiving an additional four antenatal lifestyle intervention sessions by a midwife trained in motivational lifestyle intervention. Anxiety (State and Trait Anxiety Inventory) and feelings of depression (Edinburgh Depression Scale) were measured during the first, second and third trimesters of pregnancy. Socio-demographical, behavioural, psychological and medical variables were used for controlling and correcting outcome variables. RESULTS: We found a significant reduction of GWG in the brochure (9.5 kg) and lifestyle intervention (10.6 kg) group compared with normal care group (13.5 kg) (P=0.007). Furthermore, levels of anxiety significantly decreased in the lifestyle intervention group and increased in the normal care group during pregnancy (P=0.02); no differences were demonstrated in the brochure group. Pre-pregnancy BMI was positively related to levels of anxiety. Obese pregnant women who stopped smoking recently showed a significant higher GWG (ß=3.04; P=0.01); those with concurrent gestational diabetes mellitus (GDM) (ß=3.54; P=0.03) and those who consumed alcohol on a regular base (ß=3.69; P=0.04) showed significant higher levels of state anxiety. No differences in depressed mood or obstetrical/neonatal outcomes were observed between the three groups. CONCLUSIONS: A targeted lifestyle intervention programme based on the principles of motivational interviewing reduces GWG and levels of anxiety in obese pregnant women.

Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis.

This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial trauma between January 2000 and January 2009 in the Department of Oral and Maxillofacial Surgery of the VU University Medical Center, Amsterdam. Patients' records were reviewed for complaints and information related to deep venous thrombosis (DVT) and pulmonary embolism (PE). The patients were classified according to a risk classification, and the incidence of reported DVT and PE was calculated. None of the patients received any form of thromboembolism prophylaxis. Of the 479 patients included in this study, one presented with VTE (0.2%). This male patient was treated for a panfacial trauma and was classified as high risk. From all analysed parameters only surgery time classification proved to have a significant relationship with VTE.

High levels of antenatal maternal anxiety are associated with altered cognitive control in five-year-old children.

This longitudinal prospective study examined the relation between maternal anxiety during pregnancy and specific aspects of children's cognitive functioning at age five. Antenatal maternal state-anxiety was measured around the 16th week of pregnancy. Children's neurocognitive functioning was examined using a simple reaction time (RT) task, and a choice RT task. Multiple regression analyses in the total sample (N = 922) showed that antenatal anxiety was positively related to children's intra-individual variability in RT in the simple task. In a subsample (n = 100) of women with state-anxiety scores above the 90th percentile, antenatal anxiety was positively associated with mean RT and intra-individual variability in RT in the incompatible trials of the choice RT task. In addition, in this subsample of highly anxious mothers we found a significant positive association in boys but not in girls, between prenatal maternal anxiety and intra-individual variability in RT in the simple task.

Socio-demographic and obstetrical correlates of pre-pregnancy body mass index and gestational weight gain.

Both pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are important determinants of a healthy pregnancy outcome and may show important variation. To study the influence of socio-demographic and obstetrical correlates on pre-pregnancy BMI and GWG, data of 54 022 singleton term pregnancies were analysed using adjusted regression models. In 2009, in the Northern region of Belgium, one-third of women were overweight (21.6%) or obese (10.1%) and GWG as recommended by the Institute of Medicine occurred in only 28% of obese women. A high pre-pregnancy BMI was significantly associated with low maternal education, high maternal age and multiparity, belonging to ethnic minority groups and a lower professional state. Compared to adequate GWG, excessive GWG was more common in younger (<20 years) women, with higher pre-pregnancy BMI and pregnancy-induced hypertension. Moreover, younger (20-24 years), single women, belonging to ethnic minority groups showed higher odds for excessive as well as insufficient GWG, while those with high/highest educational level had lower odds for excessive (odds ratio [OR] 0.76; confidence interval [CI] 0.72-0.80) and insufficient (OR 0.93; CI 0.89-0.98) GWG. The results of this study highlight the scale of the problem of maternal obesity and excessive GWG for this region and offer opportunities to target educational campaigns and intervention programmes in the clinical setting.

Postoperative radiographs after maxillofacial trauma: Sense or nonsense?

The purpose of the present study was to investigate the necessity of routine postoperative radiographic analysis in patients with maxillofacial trauma. Between January 2000 and January 2010, 579 patients were treated surgically for 646 maxillofacial fractures including complex maxillofacial trauma. The incidence of surgical retreatments based on postoperative radiographs after maxillofacial trauma were investigated. 16 patients needed surgical retreatment. The decision to revise was based on postoperative imaging alone in one patient (0.2%). The available data in the literature concerning postoperative radiography in maxillofacial trauma was reviewed. Six useful studies concerning postoperative radiography in maxillofacial trauma were available for review. When combining these studies a total of 1377 patients underwent surgery for correction of a maxillofacial fracture. Nine patients returned to the operating theatre for correction of the initial procedure after trauma (0.7%). The present results are in line with the available literature. Routine postoperative radiography is not necessary after surgical treatment of maxillofacial trauma. Avoiding routine postoperative radiography will lead to a reduction in exposure of patients to ionizing radiation, a reduction of costs and probably a more efficient discharge.

Stress, glucocorticoids and liquorice in human pregnancy: programmers of the offspring brain.

A suboptimal prenatal environment may induce permanent changes in cells, organs and physiology that alter social, emotional and cognitive functioning, and increase the risk of cardiometabolic and mental disorders in subsequent life ("developmental programming"). Although animal studies have provided a wealth of data on programming and its mechanisms, including on the role of stress and its glucocorticoid mediators, empirical evidence of these mechanisms in humans is still scanty. We review the existing human evidence on the effects of prenatal maternal stress, anxiety and depression, glucocorticoids and intake of liquorice (which inhibits the placental barrier to maternal glucocorticoids) on offspring developmental outcomes including, for instance, alterations in psychophysiological and neurocognitive functioning and mental health. This work lays the foundations for biomarker discovery and affords opportunities for prevention and interventions to ameliorate adverse outcomes in humans.

The BOLD correlates of the visual P1 and N1 in single-trial analysis of simultaneous EEG-fMRI recordings during a spatial detection task.

Simultaneous EEG-fMRI measurements can combine the high spatial resolution of fMRI with the high temporal resolution of EEG. Therefore, we applied this approach to the study of peripheral vision. More specifically, we presented visual field quadrant fragments of checkerboards and a full central checkerboard in a simple detection task. A technique called "integration-by-prediction" was used to integrate EEG and fMRI data. In particular, we used vectors of single-trial ERP amplitude differences between left and right occipital electrodes as regressors in an ERP-informed fMRI analysis. The amplitude differences for the regressors were measured at the latencies of the visual P1 and N1 components. Our results indicated that the traditional event-related fMRI analysis revealed mostly activations in the vicinity of the primary visual cortex and in the ventral visual stream, while both P1 and N1 regressors revealed activation of areas in the temporo-parietal junction. We conclude that simultaneous EEG-fMRI in a spatial detection task can separate visual processing at 100-200 ms from stimulus onset from the rest of the information processing in the brain.

The potential of practical checklists in successful health policy review and implementation.

The potential use of checklists to encourage the translation of policy into practice is outlined. The policy for the checklists is the WHO/UNODC declaration on women's health in prison; the checklists will be for decision makers and policy advisers; senior prison management staff; and prison health staff. The checklists will be piloted through the WHO network for prison and health and published in 2011.

Acute drug-related mortality of people recently released from prisons.

The rate of acute drug-related mortality, or overdose deaths, among prisoners in the immediate post-release period is unacceptably high. Such incidents result from many factors, including decreased tolerance after a period of relative abstinence during imprisonment and the concurrent use of multiple drugs which, with every additional illicit drug consumed in combination with opioids, nearly doubles the risk of death from opioids. Other important factors are the lack of pre-release counselling, post-release follow-up and failure to identify those at risk. Substance dependence is a chronic disorder with high relapse rates and often requires long-term continuous treatment. The deaths are preventable and a number of interventions including opioid substitution treatment reduces the risk of overdose among opioid users after release.

Health protection in prisons: the Madrid Recommendation.

At an international conference held in October 2009 in Madrid, experts in harm reduction and in the control of communicable diseases generally and in prisons agreed the Madrid Recommendation. This paper outlines the recommendations for health protection in prisons and draws attention to its call for action.