Effects of herd management decisions on dairy cow longevity, farm profitability, and emissions of enteric methane - a simulation study of milk and beef production

Sustainable dairy and beef production provides environmental, economic, and social values that can potentially be maximized by optimizing herd management strategies. The length of a dairy cow's life is affected by, and affects, all three pillars of sustainability. Longevity in dairy cows is multifactorial and strongly dependent on herd management. Despite genetic improvements, the average time of culling for Swedish cows has barely changed and is currently at 2.6 lactations. This culling rate requires a high number of replacement heifers, generating high rearing costs for farmers. This study evaluated different herd management strategies to improve cow longevity and assessed the effects on enteric methane (CH4) emissions from the herd and the profitability of milk production and beef production from the dairy cows and their offspring. The base scenario, an average Swedish Holstein herd of 100 cows, was compared with seven scenarios simulated using a stochastic herd simulation model (SimHerd). Two of these scenarios involved improved health and survival of cows in the herd, three involved improved reproduction, one considered the consequences of keeping all surplus heifers in the herd, and one considered maximizing the use of X-sorted dairy semen and inseminating the rest of the herd with unsorted beef semen, to avoid surplus replacement heifers. Improved fertility had the greatest effect in increasing the productive life per cow, to 3.8 years compared with 2.8 in the base scenario, allowed for more use of beef semen, reduced the number of replacement heifers, and generated the highest herd profit (€98 per cow-year higher than base scenario). Keeping all surplus heifers instead of producing beef × dairy cross calves decreased the number of productive years by 0.8 and reduced profit by €22 per cow-year. The profit was highly associated with costs related to replacement heifers. The highest beef output (3 369 kg per year more than base scenario) was achieved by keeping all heifers and culling a high share of dairy cows, but this scenario also generated much higher enteric CH4 emissions (+1 257 kg per year). Improving health, survival, or fertility reduced enteric CH4 emissions by 90-255 kg per year, while total yearly beef production ranged from 59 kg less to 556 kg more than in the base scenario. Reducing the number of replacement heifers needed by improving cow reproductive performance is thus key to increasing cow longevity and profitability, while reducing enteric CH4 emissions from the herd without compromising milk and meat production.

Dairy cow longevity and farm economic performance: Evidence from Swedish dairy farms

The longevity of dairy cows is mainly determined by farmers' subjective culling decisions and can be linked to the environmental impact of dairy production and to the social acceptance of the industry. Still, the economic impacts of dairy cow longevity are not well understood. The aim of this study was to examine how herd average dairy cow longevity is related to the farm economic outcome. We used 3 indicators of economic outcome: technical efficiency, profitability, and average milk yield per cow. We used 2 indicators of dairy cow longevity: average herd length of life and average herd length of productive life. The study was based on a unique and detailed dataset from Swedish dairy agriculture, where herd-management data from the national dairy herd recording scheme were combined with farm-level economic variables from the Swedish Farm Accountancy Survey, for a total of 1,959 observations from 2010 to 2018. The regression results highlight that both measures of average herd dairy cow longevity have an overall positive and significant association with farm-level economic performance. These associations had an inverted U-shape, which implies that the association is first positive and then declines. Descriptive statistics indicate that the point where the maximum economic performance is attained varied across the economic indicators. Our results are relevant for individual dairy farmers and their advisors, who are interested in understanding how herd average longevity relates to economic performance on the farms. Our results are also important from a greater sustainability perspective, because linking them to previous knowledge about the environmental and social sustainability benefits of keeping cows longer highlights longevity-associated trade-offs between those benefits and the farm economic outcomes.

Increased expression of LAT1 in basal cell carcinoma - implications for tumour cell survival

BACKGROUND

Basal cell carcinoma (BCC) is the most common type of cancer in fair-skinned individuals worldwide. Altered metabolism is a hallmark of cancer, and a growing body of evidence has shown increased expression of the large neutral amino acid transporter (LAT) small subunit 1 in several types of cancers, including BCC. However, the mechanisms behind changed LAT1 expression in BCC are largely unknown.

OBJECTIVES

To describe the protein expression of LAT1 and its co-localisation with LAT2, and to examine LAT1 in association with BCC tumour biology characteristics such as cell proliferation, apoptosis, and hypoxia.

METHODS

Formalin-fixed and paraffin-embedded tissue samples (n=14) from excised BCCs were stained with immunofluorescence and examined regarding protein-staining patterns.

RESULTS

There was no correlation between expression of LAT1 and LAT2, and the co-localisation was low. The proliferation markers topoisomerase IIα and Ki-67 both showed a significantly higher expression in the BCC tissue than in the normal epidermis (p=0.0063 and p=0.010, respectively). The fraction of LAT1-expressing cells in the BCC was inversely correlated to the fraction of proliferative active tumour cells (p=0.0013). Cleaved caspase-3 was significantly increased in tumour areas with high LAT1 expression (p=0.016).

CONCLUSIONS

The findings of the present study show that LAT1 is not usually expressed by proliferating BCC cells. The morphological localisation suggests that tumour cells use LAT1 in adaption to environmental changes such as starvation and/or hypoxia. These findings could have implications for future development of LAT1-inhibitory BCC treatments.

Continued wearing of gloves: a risk behaviour in patient care

Background

The wearing of gloves is included in the standard principles for preventing healthcare associated infections. A continued wearing of gloves may, however, result in the transmission of organisms instead of preventing infections. Few studies have explored how common it is for surfaces to be touched by potentially contaminated gloves.

Methods

Secondary analysis of field notes from 48 hours of unstructured observations of healthcare personnel's actions during patient care. The new focus was on to what extent healthcare personnel wore gloves that should have been removed or changed, what surfaces were touched by contaminated gloves and what patient-related activities were involved.

Results

A continued wearing of gloves occurred in about half of the observed episodes of patient care. On average, 3.3 surfaces were touched by contaminated gloves. The surfaces most frequently touched were ‘unused single-use items’, ‘equipment controls/switches/regulators/flush buttons’ and ‘bed linen’. This occurred mostly while helping patients with ‘personal hygiene’, when performing ‘test taking’ or during procedures involving the operation of medical or other ‘equipment’.

Conclusion

The continued wearing of gloves during patient-related activities carries the risk of organism transmission, as the gloves touch many surfaces. The most critical moments seem to be when the use of gloves is considered essential. A better understanding of the motivators of improper glove-use behaviour is needed to develop interventions that rectify the improper use of gloves.

Malignant rhabdoid tumor arising in a mixed epithelial, stromal tumor of kidney: report of a male case, review of the literature

Mixed epithelial and stromal tumor (MEST) of the kidney is a rare biphasic tumor composed of both stromal and epithelial components, the latter showing a variable proportion of solid to cystic areas. These tumors show a marked female predominance, commonly occur in perimenopausal age groups, and often have an ovarian-type stroma with ER and PR positivity, suggesting steroids may play a role in pathogenesis. Although typically benign, rare cases showing malignant transformation have been reported. We present a case of a 42-year-old man with a 10 cm right kidney mass located in the renal pelvis. Histologically, the majority of the tumor was composed of a diffuse, sheet-like growth of malignant cells demonstrating a rhabdoid morphology with large nuclei, prominent nucleoli, and eosinophilic eccentric cytoplasm. Brisk mitotic activity and coagulative type necrosis was also noted. Intimately associated with this malignant rhabdoid component was a much smaller portion of tumor featuring variably sized bland epithelial tubules embedded within a stroma composed of bland spindle cells and areas of hyalinization, diagnostic of MEST. By immunohistochemistry, the malignant rhabdoid tumor portion of the neoplasm showed complete loss of nuclear INI-1, while the MEST component retained nuclear expression of this antigen. With these features taken together, our case represents a malignant rhabdoid tumor arising in a background of MEST. To our knowledge, this case represents the first case of a MEST showing malignant transformation in the form of malignant rhabdoid tumor in a male patient in the English language literature.

Reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) - A pilot testing of the tool

OBJECTIVES

To evaluate the test-retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents.

METHOD

Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated.

RESULTS

The test--retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC_2. = 0.78--0.91 and MAINtAIN(S)-barriers subscales from ICC_2.1 = 0.60--0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults.

Atopic dermatitis, educational attainment and psychological functioning: a national cohort study

BACKGROUND

Atopic dermatitis (AD) might adversely affect academic performance, possibly through influences on psychological functioning such as stress resilience.

OBJECTIVES

To investigate the association of atopic dermatitis with stress resilience, cognitive function and educational attainment.

METHODS

We used data from a national cohort of men who underwent a military conscription examination at ages 17-20 years in Sweden between 1969 and 1976. All potential conscripts met a physician who assessed current or previous history of AD. Stress resilience was measured by a psychologist using a semistructured interview. The conscription assessment included a written cognitive function test. The highest level of education achieved was identified through record linkage.

RESULTS

The study population included 234 715 men, 1673 (0·7%) of whom had a diagnosis of AD. AD was associated with a greater risk of low stress resilience [adjusted relative risk ratio (RRR) 1·60, 95% confidence interval (CI) 1·38-1·86]. AD was associated with higher cognitive function (β-coefficient 0·15, 95% CI 0·05-0·24) and higher educational level (RRR 1·29, 95% CI 1·13-1·47). However, adjustment for socioeconomic characteristics of the family of origin attenuated the magnitude of the associations and eliminated the statistical significance (β-coefficient 0·06, 95% CI -0·03 to 0·15; RRR 1·16, 95% CI 1·00-1·35).

CONCLUSIONS

Swedish men with AD had lower stress resilience in late adolescence but did not have lower cognitive function or poorer educational attainment. The lower stress resilience associated with AD is consistent with an increased risk of possible long-term adverse health outcomes.

Expression profile of the amino acid transporters SLC7A5, SLC7A7, SLC7A8 and the enzyme TDO2 in basal cell carcinoma

Background

The incidence of basal cell carcinoma (BCC) is increasing and the costs for care rising. Therefore, the need for simplified and cost‐effective treatment choices is substantial. Aberrant signalling in several pathways, induced by ultraviolet radiation, is of importance in the development of BCC. Alterations in tumour metabolic activity are part of general carcinogenesis; however, these alterations are only partially recognized in skin cancer.

Objectives

To study expression profiles in BCCs compared with individually matched nontumour skin, with a focus on finding differences associated with tumour metabolism.

Materials and methods

Gene expression in biopsies from BCCs (n = 14) compared with biopsies from nontumour gluteal skin was analysed with microarrays (n = 4 + 4) and/or quantitative real‐time polymerase chain reaction (qPCR, n = 14 + 14). Protein expression and localization was assessed using immunohistochemistry (IHC) in formalin‐fixed and paraffin‐embedded BCC samples.

Results

Microarray analysis revealed increased expression of the amino acid transporters SLC7A5, SLC7A7 and SLC7A8 as well as the cytosolic enzyme tryptophan 2,3‐dioxygenase (TDO) 2 in BCC. Higher expression of SLC7A5 (P < 0·001), SLC7A8 (P < 0·001) and TDO2 (P = 0·002), but not SLC7A7 (P = 0·50), was confirmed by qPCR, and IHC demonstrated correlating tumour cell protein expression of SLC7A5 and SLC7A8. Protein expression of SLC7A7 was observed in the stratum granulosum, and TDO2 in immune cells.

Conclusions

This study highlights the upregulation of SLC7A5, SLC7A8 and TDO2 in BCC compared with nontumour skin. Our findings imply that amino acid transporters may be further explored as potential targets for future medical treatment.

What's already known about this topic?

The incidence of basal cell carcinoma (BCC) is increasing and consequently also the costs of care.

The transport and metabolism of amino acids are often altered in tumours although the knowledge of whether this applies to BCCs is limited.

What does this study add?

Alterations of amino acid transporters SLC7A5 and SLC7A8 and the cytosolic enzyme TDO2 is suggested in BCC and are possible potential targets for treatment.

SLC7A7 (transporter of e.g. lysine) is expressed in the stratum granulosum of normal epidermis and may be involved in the cornification process.

What is the translational message?

We have found tumour‐specific changes in proteins involved in nutrient transport and metabolism.

These changes may be of importance for carcinogenesis and should be explored further for future drug development.

Linked Comment: O’Shaughnessy. Br J Dermatol 2019; 180:16–17.

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The gene for staphylococcal protein A

Protein A from Staphylococcus aureus has become an important tool in immunology and molecular biology due to its specific binding to the constant region of immunoglobulins (Igs) from most mammalian species(1). Many qualitative and quantitative techniques have been developed which take advantage of this 'pseudo-immune' reaction(2). In addition, solid state protein A has recently been introduced in medical therapy to decrease the amount of circulating immune complexes in sera(3). In this article Mathias Uhlén, Martin Lindberg and Lennart Philipson describe the structure of the protein A molecule and its gene. They also discuss the possibilities for fusing the protein A gene to other genes.

Health-related quality of life, depression and anxiety correlate with the degree of hirsutism

BACKGROUND

Hirsutism has a negative impact on women's quality of life. The relation between quality of life, anxiety, depression and the level of hairiness has not been described.

AIMS

To investigate the correlations between the levels of hairiness, quality of life, anxiety and depression.

METHODS

200 patients from Malmö, Örebro and Uppsala, who had been in contact with the clinics for problems with excessive hair growth, were invited to answer a self-administered questionnaire including sociodemographic questions, EQ-5D index score, Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS) and Ferriman-Gallwey scale (F-G); of these, 127 women participated in the study.

RESULTS

The mean values were: EQ-5D index 0.73 (SD = 0.27), EQ visual analogue scale 61.0 (SD = 22.6), HADS-anxiety 9.5 ± 5.3 and HADS-depression 6.5 ± 4.6. The mean DLQI was 11.8 ± 8.4, indicating a very large effect on patients' lives. All were significantly correlated with the amount of hairiness.

CONCLUSIONS

Higher levels of hair growth were significantly correlated with a lower level of quality of life and symptoms of both anxiety and depression.

Abstract P2-19-05: Inhibitor Screening Utilizing Human Kinase Multiplex Arrays

Protein kinase pathways show dysregulation in cancer, usually displaying increased activation. Kinases are typically influenced by extracellular signals, and many kinases are now considered to be therapeutic targets. Upon phosphorylation, kinases regulate signaling pathways that effect cellular processes. Individual cell lines, including cancer cells, express different kinase activation patterns. Previously, we have shown the phospho-tyrosine kinase profile of MDA-MB-453 cells, most notably the Erb family of Receptor Tyrosine Kinases, to be hyperactivated in this breast cancer cell line. Using a new kinase multiplex plate-based array, we have seen similar activation of multiple intracellular kinases, such as Akt and Erk. As a result, the MDA-MB-453 cells were selected for treatment with a kinase inhibitor library (Enzo, Catalog # BML-2832-0100). While several of the inhibitors block kinase activation, other inhibitors block proteins that are upstream from their kinase target. After incubation with the inhibitor library, a multiplex kinase array was utilized to screen the effects of the inhibitors on the MDA-MB-453 cells. In contrast with MCF-7 cells, MDA-MB-453 breast cancer cells showed a basal hyperactivation of the Akt and GSK-3β kinases. The activation of Akt could be selectively inhibited by SB-203580, SB-202190, ML-7, and BML-265 inhibitors. The results obtained in the multiplex assay were verified by singleplex ELISA for Akt. Hence, the data collected with the multiplex assay provide a rapid analysis of the inhibitors’ effects on defined signaling pathways. This allows for a faster identification of kinase inhibitors that may affect cancer cells.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-19-05.

The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care

RATIONALE, AIMS AND OBJECTIVES

The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC).

METHOD

The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured.

RESULTS

The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome.

CONCLUSIONS

Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.

Possible gender differences in the quality of life and choice of therapy in acne

BACKGROUND

Acne is a very common skin disease that has major impact on the patients' quality of life. Although the disease has been extensively studied we still need more knowledge of factors influencing the decisions for choice of therapy.

OBJECTIVE

To evaluate the relationships between clinical severity, patients' self-reported quality of life, treatment choice and the outcome of therapy in a structured out-patient acne clinic.

METHODS

In total 211 consecutive patients (143 females, 68 males) at a structured acne clinic were included. At the first visit a clinical assessment was conducted, therapy was initiated and the patients answered a quality-of-life questionnaire (Dermatology Life Quality Index, DLQI). A follow up was performed after six months, when patients once again answered the DLQI questionnaire and the clinical outcome was assessed by the physician.

RESULTS

The quality of life was improved after treatment at a group level. At the first visit, the quality of life showed a gender difference (females scoring worse) but did not correlate to the clinical grading nor to the choice of therapy. At six months the DLQI correlated with clinical outcome. Patients with isotretinoin therapy showed a significantly greater improvement in quality of life. There was a tendency to gender difference in the choice of therapy, as in females 32% of the patients were treated with isotretinoin although they were clinically graded as moderate. The corresponding figure for males was 23%. A correlation was found between the initial clinical grading and gender, age and the choice of therapy.

CONCLUSION

DLQI can be used to evaluate treatment effects in acne. However, the self-reported quality of life will depend on several factors including age, gender, psychosocial factors and clinical severity.

Monitoring of Lawsonia intracellularis in breeding herd gilts

In modern pig production, proliferative enteropathy is a common cause of diarrhoea and poor growth in young animals. This study aimed to determine the possible spread of Lawsonia intracellularis through the sale of replacement gilts and the possibility to protect the herds by adequate biosecurity measures. This was achieved by repeated sampling of 50 gilts in an infected multiplying herd, from the last day in the farrowing pen and until sale. Further, 60 gilts sold from this herd were tested during their stay in quarantine in a recipient herd. To confirm freedom from infection, 100 growing pigs in the recipient herd were also tested. Individual faecal (n=748) and blood (n=728) samples were analysed by PCR and ELISA, respectively. Transmission of L. intracellularis from the sows to their offspring was not demonstrated. However, the possible transmission between herds by replacement gilts was demonstrated. Peak shedding occurred at 12 and 15 weeks of age, and single animals were also PCR-positive at 24-36 weeks of age in the multiplying herd and in the quarantine in the recipient herd. Further, the possible occurrence of chronically infected carrier animals was suggested. Although L. intracellularis is widely spread, it appears possible to avoid the transmission between herds by employing adequate biosecurity measures. Thus, it would be advisable to establish herd profiles in breeding herds to avoid the selling of infected animals as well as to establish the health status of the recipient herd. Further, the health status of the recipient herds should be known.

Post-release and pre-spawning behaviour of simulated escaped adult rainbow trout Oncorhynhus mykiss in Lake Ovre Fryken, Sweden

Using radio telemetry, the present study simulated the escape of 48 adult rainbow trout Oncorhynchus mykiss from a net-cage fish farm in the Lake Ovre Fryken, Sweden. The post-release dispersal of O. mykiss was fast, showed long-range dispersal behaviour, low winter survival and lacked the ability to find suitable spawning habitats. Thus, the present study suggested that reproducing for the first time may be an obstacle to the establishment of escaped farmed O. mykiss.

Postweaning multisystemic wasting syndrome (PMWS) in Sweden from an exotic to an endemic disease

Postweaning multisystemic wasting syndrome (PMWS) is causally associated with porcine circovirus type 2 (PCV2) infection of pigs. PCV2 was first demonstrated in Swedish pigs in 1993, although the virus was almost certainly present in pigs in the country before that. Despite this, no signs of PMWS were observed in pigs of Sweden until the first outbreak was reported in 2003. The accumulated number of PMWS-affected herds have increased via 16 (2004) and 41 (2005) to 123 in December 2006. Of these herds, 30 (25%) have now been declared free from PMWS. However, a number of other herds have had individual pigs that have fulfilled the demands for PMWS at necropsy and 52 of these herds have been declared negative on herd basis after treatment for intestinal or respiratory diseases, and/or by correcting shortcomings in management of the herd including feed. Thus, individual cases of the disease have been observed in around 200 herds by the end of 2006 and PMWS is now regarded as an endemic disease in Sweden. The pig population of Sweden is geographically isolated, the density of pigs and the pathogen load in the country is low and the use of growth promoters (low dose antibiotics in feed) was prohibited in 1986. Additionally, the trade of animals in Sweden is organised in a restricted way. Because of these factors it is possible to conduct meaningful real-time studies on the transformation of PMWS in Sweden from being an exotic to an endemic disease in a three year time scale. Initially the PMWS cases were concentrated in the southern part of Sweden, but have gradually spread north. The PMWS-positive herds have, in general, had an effective production, but some management errors have constantly been observed in affected herds. Physical links between affected herds are often missing, and the data generated to date on the PMWS outbreaks in Sweden do not suggest an introduction of a new contagious microbe into the country that is responsible for the PMWS outbreaks, nor does PMWS appear to be spread via semen. In Sweden, intensity in rearing, disease preventing measures and immaturity of the piglets appear to be important as predisposing factors to PMWS and, as such, are discussed in this article.

The role of glitazones in management of type 2 diabetes. A dream or a nightmare?

Glitazones have been introduced as second-step medication for type 2 diabetics, and today rosiglitazone and pioglitazone are blockbuster drugs. However, glitazones may have important adverse effects that outweight their beneficial effect on insulin resistance and glycemia. The larger trials have shown that glitazones produce a weight gain of 4-5 kg over 3-4 years of treatment, and the weight gain cannot be explained by fluid retention. Moreover, the risk of myocardial infarction is increased by 43% by rosiglitazone, and there are clear indications of increased risk of heart failure. Furthermore, there are studies to suggest that glitazones also increase the risk of fractures, whereas an increased cancer risk is not supported. In conclusion, given the increased cardiovascular risk, and that a weight gain of few kg can increase risks of cancer of the breast, colon, prostate and endometrium, the use of glitazones should be questioned. There is a need for more safe and weight neutral drugs to treat type 2 diabetes.

Mortality, morbidity and occupational exposure to airway-irritating agents among men with a respiratory diagnosis in adolescence

OBJECTIVES

To examine the influence of an airway diagnosis in adolescence on future health and occupation in Swedish men.

METHODS

Data were collected from the linkage of four Swedish national registers: the Military Service Conscription Register, the Population and Housing Censuses, the Inpatient Care Register and the National Cause of Death Register. A job-exposure matrix for airway-irritating substances was developed for application on the conscription cohort. The cohort included 49 321 Swedish men born 1949-51. Three groups-(1) healthy, (2) asthmatics (mild and severe asthma) and (3) subjects with allergic rhinitis without concurrent asthma-were identified at conscription and analysed for mortality, in-patient care and strategies for choice of occupation with emphasis on airway-irritating job exposure. Analyses were adjusted for smoking and childhood socioeconomic position.

RESULTS

The prevalence of total asthma was 1.8%, severe asthma 0.45% and allergic rhinitis 2.7%. Mortality for all causes was significantly higher in total asthma, hazard ratio (HR) 1.49 (95% CI 1.00 to 2.23), and lower in allergic rhinitis, HR 0.52 (95% CI 0.30 to 0.91). Asthma was a risk factor for inpatient care while allergic rhinitis was associated with less in-patient care (odds ratio (OR) for total asthma 1.16 (95% CI 1.00 to 1.34), severe asthma 1.38 (95% CI 1.04 to 1.85), allergic rhinitis 0.92 (95% CI 0.82 to 1.03)). Those with asthma tended to avoid jobs with a high probability for airway-irritating exposure (OR 0.88, 95% CI 0.71 to 1.09), but not to the same extent as subjects with allergic rhinitis (OR 0.58, 95% CI 0.47 to 0.70) (ORs from 1990).

CONCLUSION

Subjects with asthma did not change their exposure situation to the same extent as subjects with allergic rhinitis. Further, asthmatics had an increased risk for morbidity and mortality compared to healthy subjects and subjects with allergic rhinitis.

Changes in skin barrier function following long-term treatment with moisturizers, a randomized controlled trial

BACKGROUND

Moisturizers are commonly used by patients with dry skin conditions as well as people with healthy skin. Previous studies on short-term treatment have shown that moisturizers can weaken or strengthen skin barrier function and also influence skin barrier recovery. However, knowledge of the effects on skin barrier function of long-term treatment with moisturizers is still scarce.

OBJECTIVES

To investigate the impact of long-term treatment with moisturizers on the barrier function of normal skin, as measured by transepidermal water loss (TEWL) and susceptibility to an irritant, and to relate those effects to the composition of the designed experimental moisturizers.

METHODS

Volunteers (n = 78) were randomized into five groups. Each group treated one volar forearm for 7 weeks with one of the following preparations: (i) one of three simplified creams, containing only a few ingredients in order to minimize the complexity of the system; (ii) a lipid-free gel; (iii) one ordinary cream, containing 5% urea, which has previously been shown to decrease TEWL. The lipids in the simplified creams were either hydrocarbons or vegetable triglyceride oil, and one of them also contained 5% urea. After 7 weeks, treated and control forearms were exposed for 24 h to sodium lauryl sulfate (SLS) using a patch test. TEWL, blood flow and skin capacitance of both SLS-exposed and undamaged skin were evaluated 24 h after removal of patches. Additionally, a 24-h irritancy patch test of all test preparations was performed on 11 volunteers in order to check their possible acute irritancy potential.

RESULTS

Changes were found in the barrier function of normal skin after 7 weeks of treatment with the test preparations. The simplified creams and the lipid-free gel increased TEWL and skin response to SLS, while the ordinary cream had the opposite effect. One of the simplified creams also decreased skin capacitance. All test preparations were shown to be nonirritant, both by short-term irritancy patch test and by measurement of blood flow after long-term treatment.

CONCLUSIONS

Moisturizers influence the skin barrier function of normal skin, as measured by TEWL and susceptibility to SLS. Moreover, the effect on skin barrier function is determined by the composition of the moisturizer. The ingredients which influence the skin barrier function need to be identified, and the mechanism clarified at the molecular level.

Nine-year evaluation of a polyacid-modified resin composite/resin composite open sandwich technique in Class II cavities

OBJECTIVES

The aim of this study was to evaluate in an intraindividual comparison the durability of a polyacid-modified resin composite/resin composite open sandwich restoration in a 9 years follow-up. A polyacid-modified resin composite (PMRC; compomer, Dyract) was placed as an intermediate layer and covered with resin composite (RC, Prisma TPH). A direct RC restoration was used as control.

METHODS

Each of 57 patients, received at least one pair of Class II restorations, one open sandwich and one resin composite control. In total 75 pairs of Class II restorations, 68 premolars and 82 molars, all in occlusion, were placed by two dentists. Most of the cavities were surrounded by enamel. The restorations were evaluated at baseline, 6, 12, 24, 36 months and 9 years by slightly modified USPHS criteria. Survival of restorations grouped on the two different techniques was determined using Kaplan-Meier survival curves.

RESULTS

After 9 years, 14 of 135 evaluated restorations were estimated as unacceptable, 6 in the sandwich group and 8 in the control group. Over all annual failure rate during the 9-year period was 1.1%. The survival rate was not significant different between the two techniques (p=0.604). Reasons of failure were: secondary caries (8), fracture of tooth (1), fracture of restoration (2), endodontic treatment (3).

CONCLUSIONS

Both restorative techniques showed good durability during the 9-year period. No clinical advantage was observed for the sandwich technique.

Remembering childhood atopic dermatitis as an adult: factors that influence recollection

BACKGROUND

Atopic dermatitis (AD) is common in the population, and studies have shown that the disease is on the increase. Studies based on hospital records reflect selected populations and may miss less severe cases of AD, and the use of self-reported questionnaires has the drawback of recall bias.

OBJECTIVES

To investigate some possible factors influencing recall bias when questionnaires are used to establish the prevalence of childhood eczema in an adult population.

METHODS

A questionnaire regarding past and present eczema was sent to 557 cases (with signs suggesting the diagnosis AD) and 554 matched controls (subjects lacking signs of AD) born during 1960-1969 and identified in school health medical records. Cases and controls were aged 31-42 years at the time of the study and 70.5% returned the questionnaire.

RESULTS

Of 403 cases, 29% did not report childhood eczema in the questionnaire. There was a difference between those who did recall their childhood AD (remembering group, RG), and those who did not (forgetful group, FG) in who had documented the diagnostic signs in the school health records. In the RG the signs were reported by both parents and school health personnel in 51% of cases, and in the FG this was true of only 16%. The RG had a higher prevalence of eczema after 15 years of age and of hand eczema. The RG also reported more visits to physicians after the age of 15 years and more time taken as sick leave due to eczema.

CONCLUSIONS

Several factors influence how well people remember their AD in childhood. These factors include disease activity in adult life, disease severity, and who noticed the eczema in childhood.

Patch testing with methyldibromo glutaronitrile, a multicentre study within the EECDRG

Contact allergy to and allergic contact dermatitis from methyldibromo glutaronitrile (MDBGN) have frequently been reported. As there has been no agreement on which MDBGN test preparation to use, a study was initiated to help determine the optimal patch test preparation for MDBGN. 2661 consecutively patch tested patients at 11 test clinics representing 9 European countries participated. Petrolatum preparations with MDBGN at 1.0%, 0.5%, 0.3% and 0.1% were inserted in the standard series. Contact allergy rates were noted in the range 4.4-1.1% following decreasing test concentrations. Reactions not fulfilling all criteria to be classified as allergic reactions could represent either weak allergic or irritant reactions, and such reactions were noted in the range 8.2-0.5% with decreasing concentrations. A significant number of these reactions represented weak allergic reactions, as allergic reactions were obtained to higher patch test concentrations in the same individual. Morphologically irritant reactions were noted only for the highest test concentrations. In summary, the contact allergy rates and frequencies of doubtful and irritant reactions vary with the patch test concentration. The final decision on patch test concentration for MDBGN should not only rely on these factors but also include information on patch test concentrations required to diagnose individual cases with allergic contact dermatitis from MDBGN as well as results of repeated open application tests.

Quantum-dot quantum-interference infrared design proposal photodetector: and modeling of performance characteristics

A novel design of an IR photodetector operating at wavelengths around 10 microm is presented. It is based on a three-level quantum coherence effect in semiconductor quantum dots as measured in balanced-homodyne detection in a Mach-Zehnder interferometer. The advantage of this design is the combination of room-temperature operation and fast response time, whereas the major drawback is the high noise-equivalent power.

Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.

Reference intervals for procalcitonin and C-reactive protein after major abdominal surgery

Procalcitonin (PCT). a new marker proposed as a diagnostic tool for bacterial infections, triggers a systemic-inflammatory reaction in the body (sepsis, septic shock) and has potential use in a wide range of patient settings. To interpret the results from PCT measurements, we depend on reference intervals established from relevant populations. PCT and C-reactive protein (CRP) concentrations were analysed in 47 patients with a normal postoperative course after major abdominal surgery. The mean concentration of PCT declines from the first day and reaches half its initial values on the second day after the operation. whereas the mean concentration of CRP increases in the first 48 h and reaches half its maximum value on the fifth day after the operation. We present a continuous reference interval for plasma PCT and CRP concentrations in the first week following major abdominal surgery. For PCT we also present a graphic display of expected mean and expected upper reference limits predicted from the value measured on the first postoperative day.

Cell membrane translocation of the N-terminal (1-28) part of the prion protein

The N-terminal (1-28) part of the mouse prion protein (PrP) is a cell penetrating peptide, capable of transporting large hydrophilic cargoes through a cell membrane. Confocal fluorescence microscopy shows that it transports the protein avidin (67kDa) into several cell lines. The (1-28) peptide has a strong tendency for aggregation and beta-structure formation, particularly in interaction with negatively charged phospholipid membranes. The findings have implications for how prion proteins with uncleaved signal peptides in the N-termini may enter into cells, which is important for infection. The secondary structure conversion into beta-structure may be relevant as a seed for the conversion into the scrapie (PrP(Sc)) form of the protein and its amyloidic transformation.

Self-reported hand eczema: symptom-based reports do not increase the validity of diagnosis

BACKGROUND

Hand eczema is a common skin disease that affects about 10% of the general population of working age in Sweden. The resulting long sick-leave periods and need for changes of work and re-training put an economic burden on society, and there is an interest in developing cost-effective epidemiological surveillance instruments such as a screening questionnaire.

OBJECTIVES

In a search for a simple screening questionnaire for hand eczema we compared the validity of a question about the presence of hand eczema with hand eczema diagnosis based on self-reported signs.

METHODS

Consecutive patients (n = 95) referred for hand eczema and people in an ongoing epidemiological survey (n = 113) participated in the study. Before seeing an experienced dermatologist they had to: (1) answer a short questionnaire about current signs and symptoms from the hands; and (2) state whether they had hand eczema on the day of examination. The minimum criteria for hand eczema diagnosed by the dermatologist ('gold standard') were erythema and papules or vesicles, or erythema and scaling and fissures/lichenification.

RESULTS

Of the 208 persons examined 93 fulfilled the criteria for hand eczema according to the 'gold standard'. Hand eczema diagnosis based on clinical signs reported in the questionnaire by the participants gave a sensitivity of 0.62 and a specificity of 0.87 in comparison with the dermatologists' diagnoses. Regarding the question about current hand eczema, agreement was good between the participants' and the dermatologists' judgements, giving a sensitivity of 0.87 and a specificity of 0.79. Comparing clinical signs reported by the participants and the findings by the dermatologists, the best agreement was for fissures, with a kappa-value of 0.65 (95% CI 0.55-0.75), and the poorest was for papules with 0.47 (95% CI 0.32-0.62).

CONCLUSIONS

It was difficult for the individual to identify skin signs compatible with the clinical diagnosis of hand eczema. Asking 'Do you have hand eczema?' had high sensitivity and specificity compared to the suggested gold standard for hand eczema. However, the validity of a screening questionnaire depends on the type of population investigated.

Self-reported dermatological problems and use of prescribed topical drugs correlate with decreased quality of life: an epidemiological survey

BACKGROUND

Skin problems are common in the population. Although a substantial fraction of the population suffers from skin conditions, we still have little information on how this affects the everyday life of the individuals concerned.

OBJECTIVES

To evaluate the impact of skin disease on health-related quality of life (HRQOL) measured with the Short Form-36 (SF-36), a multidimensional generic HRQOL instrument, from an epidemiological perspective. A further aim was to study differences in HRQOL by use of non-prescription and prescription dermatological drugs.

METHODS

The survey was carried out in the county of Uppland, Sweden in a random sample of 8000 individuals aged 20-84 years, of whom 5404 (68%) answered the questionnaire.

RESULTS

A large part of the population (20.5%) reported dermatological problems and/or use of topical dermatological drugs, with a higher frequency among women (23.3%) than men (17.3%). Persons reporting dermatological problems scored lower on all eight dimensions of the SF-36. This pattern, although weaker, persisted after adjusting for comorbid somatic as well as psychiatric diseases and complaints. Those using topical dermatological drugs on prescription generally scored lower than the other groups with skin problems: in particular, they evaluated personal health as poorer (general health perceptions), perceived more limitations in daily activities (role limitation because of emotional health problems) and felt more tired and worn out (vitality).

CONCLUSIONS

The study shows that skin disorders constitute a substantial problem in the population and cause a significant decrease in HRQOL. Furthermore, the results of this population survey point out the need for further population-based studies more specifically aimed at dermatological problems and HRQOL.

Impact of thalamic deep brain stimulation on disability and health-related quality of life in patients with essential tremor

OBJECTIVES

To evaluate the impact of thalamic deep brain stimulation (DBS) on disability and health-related quality of life in patients with essential tremor.

METHODS

Twenty seven consecutive patients were evaluated prospectively, before surgery and at a mean of 12 months (range 6-26) after thalamic DBS. Assessment tools included the Fahn-Tolosa-Marìn tremor rating scale (TRS), activities of daily living (ADL) taxonomy, Nottingham health profile (NHP) and the visual analogue scale (VAS) for measuring impact of disease on life. Additional information on the side effects of, and expectations from surgery was obtained by interview.

RESULTS

Thalamic DBS improved the ability of the patients in eating, drinking, writing, home maintenance, hobbies, and participation in society. Activities of daily life requiring bimanual skills were less improved. The emotional condition of the patients was positively affected and the negative impact of the disease on life as a whole, and on social life was decreased. Seventy per cent of the patients considered that the surgical treatment met their expectations.

CONCLUSIONS

After thalamic DBS, health-related quality of life including disability in ADL and social life were improved in patients with essential tremor.

Line narrowing and hole burning within the homogeneous linewidth: a new wave-mixing effect in two-level systems

The interaction of strong low-area pulses with two-level systems shows absorption line narrowing and hole burning within the homogeneous linewidth as a result of nonlinear wave mixing. The wave mixing results from the two-level electronic saturation nonlinearity and occurs, depending on the sign of the pulse area, as a strong absorption enhancement or gain at the transition frequency of the two-level system for resonant excitation.