Cyclospora outbreak grows to 15 states; what sleep studies miss; the words before the diagnosis — Morning Medical Update

Cyclospora outbreak grows to 15 states

Federal investigators added six states to the largest known U.S. cyclosporiasis outbreak, which has been tied to iceberg lettuce from central Mexico.

The U.S. Centers for Disease Control and Prevention (CDC) is adding six states to the cyclosporiasis outbreak linked to iceberg lettuce, widening to 15 the number of states in the largest known outbreak of the parasite in the country, the Washington Post reported Tuesday, citing people familiar with the investigation.

Arkansas, Iowa, Missouri, Nebraska, New Hampshire and North Carolina join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia. The CDC did not immediately respond to a request for comment, and the number of states could change.

Investigators have tied the outbreak to lettuce from Taylor Farms de Mexico served at Taco Bell restaurants, and the company recalled shredded iceberg lettuce July 17. The CDC website shows more than 10,468 laboratory-confirmed and 12,255 suspected cases, but the agency's surveillance lags state reporting by several weeks. Michigan, the hardest-hit state, reported 11,508 cases Tuesday, a state tally that includes probable cases, along with the outbreak's first two deaths, both in patients with significant underlying conditions. Because the incubation period is long and confirmation can take as long as six weeks, the true count is likely higher than reported. Taylor Farms did not immediately respond to a request for comment. Infection Control Today has more on the outbreak.

Related content: Cyclosporiasis outbreak: 13 things primary care physicians need to know right now

What sleep studies miss

An analysis of more than 10,000 overnight studies sorted patients into five risk groups the standard apnea index did not capture.

Artificial intelligence (AI) applied to routine polysomnography data surfaced physiologic patterns predicting a far broader range of health risks than the single measure clinicians typically rely on, according to a study published in Nature Communications. Investigators analyzed more than 10,000 full-night sleep studies against long-term outcomes in patients' medical records and identified five patient subtypes with sharply different risk profiles, none of them captured by the apnea-hypopnea index, the average number of breathing pauses and shallow-breathing events per hour.

Patients in the highest-risk subtype had twice the odds of death over five years compared with the lowest-risk group, along with 65% higher odds of heart failure, 84% higher odds of heart attack, 93% higher odds of cognitive impairment and more than 200% higher odds of atrial fibrillation and epilepsy. The model performed comparably in men and women, unlike the apnea-hypopnea index, which has historically performed better in men, and held up in a separate nationwide cohort of more than 6,000 patients.

The words before the diagnosis

How children described stressful experiences flagged future depression and anxiety up to six years out, outperforming expert stress ratings.

Machine analysis of how children talked about stressful experiences predicted the onset of depressive and anxiety disorders up to six years later, outperforming expert ratings of stress severity, according to a National Institutes of Health (NIH)-funded study published in Nature Mental Health. Researchers led by Stanford University applied four natural language processing techniques to audio from structured interviews averaging about 30 minutes with 204 children ages 9 to 13, none of whom had a mental health diagnosis at baseline, then measured outcomes at follow-ups four and six years later.

Linguistic style mattered more than content. The strongest predictors included elevated narrative complexity, marked by heavy use of function words such as prepositions, along with rigid language expressing absolute certainty and self-referential speech.

"We saw that the way kids spoke about stress exposure — the mechanics of their language, rather than necessarily what they said — was a robust predictor of the onset of anxiety and depression," said first author Chase Antonacci, a Ph.D. candidate at Stanford.