The Duluth Boat Club (DBC) Beach, located in the Duluth-Superior harbor of Lake Superior, is frequently closed in summer due to high counts of Escherichia coli, an indicator of fecal contamination. However, the sources of bacteria contributing to beach closure are currently unknown. In this study, we investigated the potential sources of E. coli contaminating the DBC beach by using modified rep-PCR (HFERP) DNA fingerprinting. Over 3600 E. coli strains were obtained from 55 lake water, 25 sediment, and 135 sand samples taken from five transects at the DBC beach at 11 different times during the summer through fall months of 2004 and 2005. Potential sources of E. coli at this beach were determined by using a known-source DNA fingerprint library containing unique E. coli isolates from wildlife, waterfowl, and treated wastewater obtained near Duluth, MN. Amounts E. coli in the samples were enumerated by membrane filtration counting, and the presence of potentially pathogenic E. coli was determined by using multiplex PCR. E. coli counts in all samples increased during the summer and early fall (July to September). While E. coli in spring samples originated mainly from treated wastewater effluent, the percentage of E. coli from waterfowl increased from summer to fall. DNA fingerprint analyses indicated that some E. coli strains may be naturalized, and autochthonous members of the microbial community in the beach sand and sediments were examined. However, multiplex PCR results indicated that <1% of the E. coli strains at the DBC was potentially pathogenic. Our results also suggest that wave action may influence the early colonization and homogeneous distribution of E. coli in beach sand and the subsequent release of sand or sediment-borne E. coli into lake water. Taken together, these results indicate that sand and sediment serve as temporal sources and sinks of human and waterfowl-derived E. coli that contribute to beach closures.

OBJECTIVES. This study investigated the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol, and smoking on intrauterine growth retardation and premature delivery. METHODS. At a Copenhagen university hospital, 2432 pregnant women completed a questionnaire on general health, psychosocial stressors, and sociodemographic characteristics. RESULTS. In 212 cases (8.7%) the women delivered prematurely. Preterm delivery as associated with psychosocial stress (adjusted odds ratio [OR]=1.14 for each 1-point increase on the psychosocial stressor 5-point scale and 1.92 for the whole scale) and poor school education (adjusted OR=2.62 for 7-9 years of schooling, 1.91 for 10 years, and 1.0 for 11-13 years). In 152 cases (6.3%), infants had a birthweight below the 10th percentile. Intrauterine growth retardation was associated with smoking, daily drinking, school education, and social network variables. In a multiple logistic regression model, intrauterine growth retardation was associated with smoking habits (adjusted OR=2.40 for 0-9 cigarettes daily, 2.68 for 10-15 daily, and 2.88 for more than 15 daily). CONCLUSIONS. Psychosocial stressors and limited duration of schooling appeared to influence preterm delivery. Smoking habits influenced intrauterine growth retardation.

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Exposure to smog, floods, 1 or earthquakes 2 has been associated with a lower sex ratio (proportion of males) in offspring conceived at the time of the exposure episode. We hypothesised that exposure to severe life events before and during the periconceptional period might be associated with a decline in the sex ratio. Methods and resultsAll Danish women who gave birth from 1 January 1980 to 31 December 1992 were identified by the population based medical birth registry. By linking personal identification numbers to the Danish statistical office's fertility database, we identified all the women's partners and older children. A partner was defined as the father of the child or the partner with whom the woman was cohabiting on 1 January in the year of birth. Severe life events were defined as death or admission to hospital for cancer (codes 140 to 209 (excluding 208 polycythemia vera) of the international classification of diseases, eighth revision) or acute myocardial infarction (code 410) in the partner or older children. By linking the personal identification numbers to the mortality registry and to the national registry of patients, we identified all deaths and all admissions to hospital of partners and children between 1978 and 1992.We identified all women exposed to severe life events in the year of birth and the previous year but included only the women exposed before the second trimester. Women with diabetic partners were excluded, as it has been reported that the sex ratio in their offspring is higher. The time of exposure was recorded as the date of death or first admission to hospital. Information on the possible confounding variables was obtained from the registries.The exposed cohort consisted of 3072 singleton pregnancies exposed to severe life events and a control cohort of 20 337 singleton pregnancies randomly selected among all pregnancies without such exposure in the observation period. Of all the offspring, 945 had congenital malformations, chromosomal abnormalities, or hereditary diseases.Using logistic regression analysis, we found that the proportion of boys was 49.0% in the exposed group and 51.2% the control group, giving a crude overall lower ratio between the two sex odds (sex odds ratio) of 0.92 and an adjusted ratio of 0.91 (95% confidence interval 0.84 to 0.99) (table). Exclusion of offspring whose mothers were exposed during the first trimester and all offspring with congenital malformations gave similar results (data not shown).The nearer the exposure was to conception, the lower the overall sex odds ratio (test for trend P = 0.013) and the lower the sex ratio for exposure by an older sibling only (P = 0.035) and for exposure by death of a partner only (P = 0.016). CommentThe results show that severe life events may reduce the sex ratio, especially for exposures around the time of conception, because of differential conception or Adjusted sex odds ratios and percentage of boys as function of severe life events before and in periconceptional period and stratified for timing of exposur...

Background-The association between psychological stress and coronary heart disease remains unclear. We conducted a prospective follow-up study based on national registers to investigate if the death of a child, one of the most severe stressors, increases the risk of myocardial infarction (MI) in parents. Methods and Results-From 1980 to 1996, 19 361 parents who lost a child (Ͻ18 years of age) in Denmark were recruited to the exposed cohort, and 295 540 parents matched on family structure were selected for the unexposed cohort. The Cox proportional hazards model was used to evaluate the relative risk (RR) of myocardial infarction (MI). The average RRs for a fatal MI and any first MI among the exposed were 1.36 (95% CI, 0.98 to 1.88) and 1.28 (95% CI, 1.08 to 1.51), respectively. The two cohorts had similar MI risk during the first 6 years of follow-up. From the 7th to the 17th year of follow-up, the exposed cohort had a RR of 1.58 (95% CI, 1.08 to 2.30) for fatal MI and a RR of 1.31 (95% CI, 1.09 to 1.57) for first MI. Parents who lost a child unexpectedly, especially from sudden infant death syndrome, experienced higher RRs. Conclusions-The death of a child was associated with an increased risk of MI in bereaved parents. (Circulation.

SUMMARY In a population‐based study, 3021 women in a central Copenhagen district received a questionnaire on environmental and psychological factors during mid‐gestation. Of these, 70 women were selected consecutively on the basis of moderate to severe stressful life‐events (DSM‐111‐R categories 3 to 5), in combination with an inadequate social network. They were compared with 50 non‐stressed women with an intact social network. Stress and smoking significantly affected birthweight and head circumference. When birthweight was corrected, stress remained a significant determinant of small head circumference, indicating a specific effect on brain development. Stress also led to a sub‐optimal Prechtl neonatal neurological score. These findings suggest the existence of a fetal stress syndrome with adverse effects on fetal development, including deficient brain development. RÉSUMÉ Les stress prénataux de la vie journalière affectent le développemeni cérébral foetal Au cours d'une étude de population, 3021 femmes d' un district central de Copenhague reçurent un questionnaire concemam les facteurs environnementaux et psychologiques a miterme. Dans ce groupe, 70 femmes furent choisies sequentiellement sur la base d'evenements provoquant un stress modere à severe (categories 3 a 5 du DSM‐111‐R) associe a un environnement social inadapte. Elles furent comparees a 50 femmes non stressees et avec environnement social intact. Le stress et le tabac affectaient significativement le poids de naissance et le tour de tete. Aprés correction sur le poids de naissance, le stress demeurait un facteur significatif de faible tour de tête, indiquant un effet specifiqiie sur le developpemeni cérébral. Le stress produit egalement un score neurologique neonatal dc Prechtl sous‐optimal. Ces donnees suggerent I'existence d'un syndrome foetal de stress avec des effets nocifs sur le developpemeni foetal, incluant un developpemeni cérébral deficient. ZUSAMMENFASSUNG .Pránatale Stressfaktoren des täglichen Lebens beeinflussen die fetale Hirnentwicklung In eincr die gesamte Bevölkerung eines Kopenhagener Wohnbezirkes umfassenden Studie erhielten 3021 Frauen cinen Fragebogen über Umwelteinflüsse und psychologische Faktoren wahrend des zweiten Sehwangerschaftstrimesters. Von diesen wurden 70 Frauen mit maßigen bis schweren Stressercignissen (DSM‐III‐R Kategorie 3–5) in Kombinaiion mit unzureichender sozialer Absicherung ausgcwahlt. Diese wurden mit einer Gruppe von 50 nicht gestressten und sozial abgesicherten Frauen verglichen. Stress und Rauchen beeinflußten signifikant Geburtsgewicht und Kopfumfang. Nach Korrektur für das Geburtsgewicht blieb Stress ein signifikanter Faktor für den Kopfumfang, d.h. Stress hat eine spezifische Wirkung auf die Hirnentwicklung. Stress war auch die Ursache für ein nicht optimales Ergebnis beim neurologischen Neugeborenentest nach Prechtl. Diese Befunde weisen auf die Fxistcnz eines fetalen Stress‐Syndroms hin, das die fetale Entwicklung und insbesondcre die Hirnentwicklung ungünstig beeinflußt. RESUMEN Los faaores est...

Background: Acquired hemolytic disorders-autoimmune hemolytic anemia (AIHA), cold agglutinin disease (CAD), paroxysmal nocturnal hemoglobinuria (PNH), drug-induced hemolysis (DIHA), and acquired hemolysis not otherwise specified (AHNOS)-are considered rare. Despite their potentially major health implications, data regarding their incidence and prevalence are scarce. Methods: To fill this gap we collected data regarding all patients with acquired hemolytic disorder diagnoses in 1977-2016 from the Danish National Patient Register. These data were linked with vital and migration status information from the Danish Civil Registration System. From these data combined with annual demographic data for the background population, we calculated age-and sex-specific incidence rates and prevalence proportions of acquired hemolytic disorders for specified time periods. Results: Our analysis included 5868 patients with acquired hemolytic disorders (2715 with AIHA, 112 CAD, 397 DIHA, 116 PNH, and 2154 AHNOS). The incidence rates per 100 000 person-years in 1980-1993 and 2008-2016 were 0.81 and 1.77 for AIHA, 0.31 and 0.12 for DIHA, and 0.04 and 0.08 for PNH, respectively. The 2008-2016 CAD incidence rate was 0.18/100 000 person-years, CAD diagnosis code was not defined before 1994. All incidence rates increased with age. The prevalence proportion per 100 000 persons in 1980 and 2015 was 2.52 and 17.01 for AIHA, 0.80 and 1.50 for DIHA, and 0.18 and 1.04 for PNH. CAD prevalence in 2015 was 1.04/100 000 persons. Conclusion: Acquired hemolytic anemia incidence rates and prevalence proportions with the exception of DIHA are markedly increasing.