Short-course subcutaneous treatment with PQ Grass strongly improves symptom and medication scores in grass allergy

BACKGROUND

A modified grass allergen subcutaneous immunotherapy (SCIT) product with MicroCrystalline Tyrosine and monophosphoryl lipid-A as an adjuvant system (Grass MATA MPL [PQ Grass]) is being developed as short-course treatment of grass-pollen allergic rhinitis (SAR) and/or rhinoconjunctivitis. We sought to evaluate the combined symptom and medication score (CSMS) of the optimized cumulative dose of 27,600 standardized units (SU) PQ Grass in a field setting prior to embarking on a pivotal Phase III trial.

METHODS

In this exploratory, randomized, double-blind, placebo-controlled trial subjects were enrolled across 14 sites (Germany and the United States of America). Six pre-seasonal subcutaneous injections of PQ Grass (using conventional or extended regimens) or placebo were administered to 119 subjects (aged 18-65 years) with moderate-to-severe SAR with or without asthma that was well-controlled. The primary efficacy endpoint was CSMS during peak grass pollen season (GPS). Secondary endpoints included Rhinoconjunctivitis Quality of Life Questionnaire standardized (RQLQ-S) and allergen-specific IgG4 response.

RESULTS

The mean CSMS compared to placebo was 33.1% (p = .0325) and 39.5% (p = .0112) for the conventional and extended regimens, respectively. An increase in IgG4 was shown for both regimens (p < .01) as well as an improvement in total RQLQ-S for the extended regimen (mean change -0.72, p = .02). Both regimens were well-tolerated.

CONCLUSIONS

This trial demonstrated a clinically relevant and statistically significant efficacy response to PQ Grass. Unprecedented effect sizes were reached for grass allergy of up to ≈40% compared to placebo for CSMS after only six PQ Grass injections. Both PQ Grass regimens were considered equally safe and well-tolerated. Based on enhanced efficacy profile extended regime will be progressed to the pivotal Phase III trial.

Introduction to the special issue: How nonclinical psychology research can inform clinical perspectives on disgust

Disgust is a universal emotion that significantly impacts human behavior and psychological well-being. While clinical psychology researchers made great strides in understanding disgust in the context of psychopathology, nonclinical researchers have contributed valuable insights that can inform clinical perspectives on disgust. This special issue aims to bring together the latest nonclinical research that can shed light on the nature, causes, and consequences of disgust-related psychopathology. The five articles in this issue cover various nonclinical topics, including inhibitory learning, autobiographical memories, food preferences, and the perception of self and others. This issue also covers the role of disgust in specific clinical disorders, including anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, eating disorders, neurodegenerative disorders, and more. By showcasing novel approaches to researching clinical aspects of disgust, this special issue provides a comprehensive and up-to-date understanding of the complex phenomenon of disgust and future directions in research.

Exploring the role of the self in disgust-related psychopathologies

While clinical research on disgust relies on nonclinical research, the framework of disgust as an immune mechanism is not as central in clinical research. The immune framework for disgust may be integrated into clinical research by acknowledging the role of the self as the critical element protected by the immune system. In this review, we offer the premise that at the center of all disgust-related behaviors, thoughts, and cognitions is an attempt to protect the self (i.e., "disgust is self-centered" or DISC). We offer evidence in support of DISC and explore the relevance of DISC to clinical research for several disgust-related psychopathologies (obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and self-disgust). We then offer future directions for DISC research into disgust-related psychopathologies.

Parent training for dependent, yet abled, young adults

The term Failure to launch (FTL) has been used to describe abled adults who do not work, do not attend school, and live with- and at the expense of-their parents. FTL can be beneficially addressed through parent training, a treatment method that is rarely used with adults (i.e., individuals past the age of majority). The authors first review the goals of parent training programs offered to parents of adults. The review demonstrates that these goals dovetail with key aspects of FTL. The authors then describe a new parent training approach for parents of individuals with FTL, based on SPACE (Supportive Parenting for Anxious Childhood Emotions). They highlight five key components of SPACE-FTL: Psychoeducation, Reducing Parental Accommodation, Increasing Parental Support, De-Escalation, and Engaging Supporters. The authors conclude by discussing SPACE-FTL in relation and comparison to other parent training programs and their components.

Impact of perceptions of body size on obesity and weight management behaviour: a large representative population study in an African setting

BACKGROUND

Perception of body size is an important psycho-cultural cause of obesity with wide racial and ethnic variations.

METHOD

Cross-sectional household survey using multistage cluster-randomised sampling. Prevalence estimates were weighted. Logistic regressions were done to determine the impact of perception of large body size on obesity and the impact of perception of own body size on weight-management behaviour. Adjusted odds ratios (AOR) were reported.

RESULTS

The survey involved 6628 adults from 2843 households. More than a quarter of the population is either obese or overweight. Nearly half, 44.07% (95% confidence interval [CI]: 42.48-45.66%) of the population perceive large body size as desirable. Positive perception of large body size significantly increases the odds of obesity by 1.5 (AOR: 1.45; 95% CI: 1.09-1.9). Some 42.03% (95% CI: 35.52-48.55%) obese persons misperceive their weight to be normal. Perceiving own body size as normal decreases the odds of weight-losing behaviour (AOR: 0.019; 95% CI: 0.014-0.026).

CONCLUSION

There is a high level of veneration of large body size in southeast Nigeria, and this has a significant impact on obesity burden. Perception of own body size has a significant impact on weight-management behaviour. Health-promotion policies aimed at changing the social desirability of large body size and misperception of body size are recommended.

Skin cancer risk and shade: comparing the risk of foresters with other outdoor workers

BACKGROUND

Keratinocyte carcinoma (KC) is an increasingly important public health problem with an especially high prevalence in outdoor workers. In contrast to other occupations, foresters spend most of their outdoor time under the shade of trees.

OBJECTIVES

We aimed to compare the unique sun exposure patterns and sun protection behaviour of foresters with those of other outdoor workers and their relation to the KC risk.

METHODS

In July 2018, a cross-sectional study was conducted at an international forestry fair using a questionnaire about health awareness and skin cancer screening by dermatologists to assess the prevalence of KC.

RESULTS

A total of 591 participants (78.7% male; mean age 46.8 ± 16.2 years) including 193 foresters were enrolled. Of all foresters, 72% experienced sunburns (solar erythema) within the past year and 50% of them experienced the worst sunburn during work. Foresters were most likely to often/always wear protective clothes (29.0%) but were least likely to often/always avoid midday sun (23.8%) and stay in the shade (31.1%). Having an outdoor profession or spending hours outside for leisure was negatively associated with sun protection. Skin examination revealed an overall KC prevalence of 16.7%, with 16.5% of foresters being affected.

CONCLUSION

Despite being protected by trees, the risk of KC for foresters is comparable to that of other professional groups. Shade alone may not provide sufficient protection. Additional sun protection measures are necessary.

Social anxiety and the interpretation of morphed facial expressions following exclusion and inclusion

BACKGROUND AND OBJECTIVES

Negative interpretation biases are postulated to play etiological and maintaining roles in social anxiety (SA). However, empirical support for interpretation biases of facial expression in SA is inconsistent. Given the importance of signals of (dis)approval in SA, our objective was to examine whether SA is associated with enhanced sensitivity to such signals especially following exclusion.

METHODS

In Study 1, participants (N = 139) underwent an exclusion/inclusion manipulation and were then presented with video clips of smiles gradually changing into disgust expressions (smile-to-disgust). In Study 2 (N = 203), participants saw smile-to-disgust as well as disgust-to-smile clips following an exclusion/inclusion manipulation. Participants' task in both studies was to detect the offset of the initial expression.

RESULTS

Results of Study 1 show that detection latency of smiles' disappearance is negatively associated with SA severity. The results of Study 2 suggest that this association is stronger following exclusion, and specific to the smile-to-disgust as opposed to the disgust-to-smile, transitions.

LIMITATIONS

Our studies did not examine whether the observed interpretation bias was specific to SA.

CONCLUSIONS

Our findings support and refine cognitive theories of SA, suggesting that interpretation biases for facial information in SA may be especially pronounced following exclusion.

New European Academy of Allergy and Clinical Immunology definition on pollen season mirrors symptom load for grass and birch pollen-induced allergic rhinitis

BACKGROUND

The use of allergen immunotherapy (AIT) for allergic rhinitis and its clinical efficacy in clinical trials depends on the effective determination of pollen allergen exposure time periods. We evaluate pollen data from Germany to examine the new definitions on pollen season and peak pollen period start and end as proposed by the European Academy of Allergy and Clinical Immunology (EAACI) in a recently published Position Paper. The aim was to demonstrate the ability of these definitions to mirror symptom loads for grass and birch pollen-induced allergic rhinitis based on real-life data.

METHODS

Data coming from four pollen monitoring stations in the Berlin and Brandenburg area in Germany and for 3 years (2014-2016) were used to investigate the correlation of season definitions, birch and grass pollen counts and total nasal symptom and mediation scores as reported by patients in "Patients Hay fever Diaries" (PHDs). After the identification of pollen periods on the basis of the EACCI criteria, a statistical analysis was employed, followed by a detailed graphical investigation.

RESULTS

The analysis revealed that the definitions of pollen season as well as peak pollen period start and end as proposed by the EAACI are correlated to symptom loads for grass and birch pollen-induced allergic rhinitis reported by patients in PHDs.

CONCLUSION

Based on our analysis, the validity of the EAACI definitions on pollen season is confirmed. Their use is recommended in future clinical trials on AIT as well as in daily routine for optimal patient care.

Long-Term Follow-Up Confirms Prognostic Impact of Pai-1 and Cathepsin D and L in Primary Breast Cancer

After long-term follow-up, the prognostic impact of the following proteolytic factors associated with tumor invasion and metastasis was evaluated in 276 primary breast cancer patients: uPA (urokinase-type plasminogen activator), PAI-1 (uPA inhibitor type 1), and cathepsins B, D and L. The median follow-up of patients still alive at the time of analysis was 109 months. To date 119 patients (43%) have relapsed and 117 (42%) have died. Antigen levels of uPA and PAI-1 were determined by ELISA in detergent extracts; cathepsin B, D, and L content was determined in cytosol fractions of the primary tumor: cathepsin D by ELSA and cathepsin B and L by ELISA.

In multivariate analysis (Cox model) for disease-free survival (DFS), lymph node status (p<0.001; RR=3.8), cathepsin L (p<0.001; RR=2.6) and PAI-1 (p=0.027; RR=1.7) were significant factors in all patients. In addition to these factors, grading was significant for overall survival (OS). In another multivariate approach, CART (Classification And Regression Trees) analysis, lymph node status (p<0.001) turned out to be the strongest discriminator for patients at high risk of relapse. In the node-negative patient subset, PAI-1 was the strongest risk group discriminator (p<0.001): in this subset, patients with low levels of both PAI-1 and cathepsin D had a very low relapse rate of only 3.2% compared to 39% in the remaining node-negative patients. In node-positive patients cathepsin L gave the best risk group assessment (p=0.001).

In conclusion, tumor-associated PAI-1 and cathepsins D and L provide significant, statistically independent prognostic information for DFS and OS in primary breast cancer, even after a median follow-up period of almost 10 years.

Possible effect of landscape design on IgE recognition profiles of two generations revealed with micro-arrayed allergens

The aim of this study was to investigate possible effects of landscape design on the IgE sensitization profile toward inhalant allergens in patients with respiratory allergy from Uzbekistan where green areas have been changed during the last two decades by a State program. Sera from two different generations of Uzbek (n=58) and, for control purposes, from two generations of Austrian (n=58) patients were analyzed for IgE reactivity to 112 different micro‐arrayed allergen molecules by ImmunoCAP ISAC technology. Changes in molecular IgE sensitization profiles to pollen allergens in the young vs the middle‐aged Uzbek population were associated with replanting, whereas those in the Vienna populations reflected natural changes in plant growth. Our data indicate that anthropologic as well as natural changes in the biome may have effects on IgE sensitization profiles already from one to another generation.

Ranking REACH registered neutral, ionizable and ionic organic chemicals based on their aquatic persistency and mobility

The contaminants that have the greatest chances of appearing in drinking water are those that are mobile enough in the aquatic environment to enter drinking water sources and persistent enough to survive treatment processes. Herein a screening procedure to rank neutral, ionizable and ionic organic compounds for being persistent and mobile organic compounds (PMOCs) is presented and applied to the list of industrial substances registered under the EU REACH legislation as of December 2014. This comprised 5155 identifiable, unique organic structures. The minimum cut-off criteria considered for PMOC classification herein are a freshwater half-life >40 days, which is consistent with the REACH definition of freshwater persistency, and a log D_oc < 4.5 between pH 4-10 (where D_oc is the organic carbon-water distribution coefficient). Experimental data were given the highest priority, followed by data from an array of available quantitative structure-activity relationships (QSARs), and as a third resort, an original Iterative Fragment Selection (IFS) QSAR. In total, 52% of the unique REACH structures made the minimum criteria to be considered a PMOC, and 21% achieved the highest PMOC ranking (half-life > 40 days, log D_oc < 1.0 between pH 4-10). Only 9% of neutral substances received the highest PMOC ranking, compared to 30% of ionizable compounds and 44% of ionic compounds. Predicted hydrolysis products for all REACH parents (contributing 5043 additional structures) were found to have higher PMOC rankings than their parents, due to increased mobility but not persistence. The fewest experimental data available were for ionic compounds; therefore, their ranking is more uncertain than neutral and ionizable compounds. The most sensitive parameter for the PMOC ranking was freshwater persistency, which was also the parameter that QSARs performed the most poorly at predicting. Several prioritized drinking water contaminants in the EU and USA, and other contaminants of concern, were identified as PMOCs. This identification and ranking procedure for PMOCs can be part of a strategy to better identify contaminants that pose a threat to drinking water sources.

Defining pollen exposure times for clinical trials of allergen immunotherapy for pollen-induced rhinoconjunctivitis - an EAACI position paper

BACKGROUND

Clinical efficacy of pollen allergen immunotherapy (AIT) has been broadly documented in randomized controlled trials. The underlying clinical endpoints are analysed in seasonal time periods predefined based on the background pollen concentration. However, any validated or generally accepted definition from academia or regulatory authorities for this relevant pollen exposure intensity or period of time (season) is currently not available. Therefore, this Task Force initiative of the European Academy of Allergy and Clinical Immunology (EAACI) aimed to propose definitions based on expert consensus.

METHODS

A Task Force of the Immunotherapy and Aerobiology and Pollution Interest Groups of the EAACI reviewed the literature on pollen exposure in the context of defining relevant time intervals for evaluation of efficacy in AIT trials. Underlying principles in measuring pollen exposure and associated methodological problems and limitations were considered to achieve a consensus.

RESULTS

The Task Force achieved a comprehensive position in defining pollen exposure times for different pollen types. Definitions are presented for 'pollen season', 'high pollen season' (or 'peak pollen period') and 'high pollen days'.

CONCLUSION

This EAACI position paper provides definitions of pollen exposures for different pollen types for use in AIT trials. Their validity as standards remains to be tested in future studies.

Monumental megalithic burial and rock art tell a new story about the Levant Intermediate Bronze "Dark Ages"

The Intermediate Bronze Age (IB) in the Southern Levant (ca. 2350–2000 BCE) is known as the “Dark Ages,” following the collapse of Early Bronze urban society and predating the establishment of the Middle Bronze cities. The absence of significant settlements and monumental building has led to the reconstruction of IB social organization as that of nomadic, tribal society inhabiting rural villages with no central governmental system. Excavation in the Shamir Dolmen Field (comprising over 400 dolmens) on the western foothills of the Golan Heights was carried out following the discovery of rock art engravings on the ceiling of the central chamber inside one of the largest dolmens ever recorded in the Levant. Excavation of this multi-chambered dolmen, covered by a basalt capstone weighing some 50 tons, revealed a secondary multi-burial (of both adults and children) rarely described in a dolmen context in the Golan. Engraved into the rock ceiling above the multi-burial is a panel of 14 forms composed of a vertical line and downturned arc motif. 3D-scanning by structured-light technology was used to sharpen the forms and revealed the technique employed to create them. Building of the Shamir dolmens required a tremendous amount of labor, architectural mastery, and complex socio-economic organization well beyond the capacity of small, rural nomadic groups. The monumental megalithic burial of the Shamir dolmens indicates a hierarchical, complex, non-urban governmental system. This new evidence supports a growing body of recent criticism stemming from new discoveries and approaches that calls for rethinking our views of the Levantine IB “Dark Ages.”

Deliberate Self-Harm in Older Adults: A General Hospital Emergency Department Survey

BACKGROUND

Deliberate self-harm (DSH) increases the danger of future suicide death and the risk increases with age. Self-harm in older adults is often associated with greater suicidal intent and lethality.

OBJECTIVES

To investigate clinical and psychosocial variables of older patients (age ≥ 65 years) assessed due to DSH, compared with younger adults.

METHODS

Patients admitted to the Emergency Department following DSH during an 8 year period were included.

RESULTS

Of 1149 participants, 187 (16.6%) were older adults (age ≥ 65) and 962 (83.4%) were younger adults (< 65). The older adults reported DSH closer to mid-day (P < 0.01) and suffered more frequently from adjustment disorder and depression. Personality disorders and schizophrenia were less commonly diagnosed (P < 0.001). Prescription medication (sedatives and hypnotics) were a more frequent means (88% vs. 71%) of DSH among older patients. Younger patients with DSH used over-the-counter medications (21.9% vs. 6.4%) three times more than did the older patients (P < 0.01). Past DSH was significantly more frequent in younger adults. Following DSH the older patients were frequently admitted for further general hospitalization (P < 0.001).

CONCLUSIONS

Older adults with DSH are a unique group with different clinical characteristics. There is a need for targeted prevention strategies and education of caregivers regarding DSH in older adults.

Spatial and temporal variations in airborne Ambrosia pollen in Europe

The European Commission Cooperation in Science and Technology (COST) Action FA1203 "SMARTER" aims to make recommendations for the sustainable management of Ambrosia across Europe and for monitoring its efficiency and cost-effectiveness. The goal of the present study is to provide a baseline for spatial and temporal variations in airborne Ambrosia pollen in Europe that can be used for the management and evaluation of this noxious plant. The study covers the full range of Ambrosia artemisiifolia L. distribution over Europe (39°N-60°N; 2°W-45°E). Airborne Ambrosia pollen data for the principal flowering period of Ambrosia (August-September) recorded during a 10-year period (2004-2013) were obtained from 242 monitoring sites. The mean sum of daily average airborne Ambrosia pollen and the number of days that Ambrosia pollen was recorded in the air were analysed. The mean and standard deviation (SD) were calculated regardless of the number of years included in the study period, while trends are based on those time series with 8 or more years of data. Trends were considered significant at p < 0.05. There were few significant trends in the magnitude and frequency of atmospheric Ambrosia pollen (only 8% for the mean sum of daily average Ambrosia pollen concentrations and 14% for the mean number of days Ambrosia pollen were recorded in the air). The direction of any trends varied locally and reflected changes in sources of the pollen, either in size or in distance from the monitoring station. Pollen monitoring is important for providing an early warning of the expansion of this invasive and noxious plant.

Motivation of patients with inflammatory bowel disease to participate in a clinical trial

Background: Clinical trials are designed to investigate innovative diagnostic and therapeutic strategies for patients. However, factors that influence patients with inflammatory bowel disease (IBD) and willingness to participate in a clinical trial are unknown. Methods: We developed a questionnaire and asked IBD patients about their willingness to hypothetically participate in a clinical trial and their current health-related quality of life by using the IBDQ. Results: Of 201 distributed questionnaires, 166 were returned and included in the analysis. One-hundred-one (61 %) patients declared their willingness to participate in a clinical trial hypothetically offered in their current situation, whereas 65 (39 %) declined. Among all patients, a trustful relationship between patient and doctor was most important for trial participation. The willingness to help others and to support medical progress were other key issues mentioned. In contrast, those patients inclined to refuse trial participation feared impairment of their current health status, potential side effects, medical examinations, and the expenditure of time and effort. Conclusion: In our cohort of IBD patients, approximately two-thirds were willing to participate in a clinical trial. We were able to identify a number of factors that should help physicians to directly address fears and break down barriers in order to increase the number of patients willing to participate in clinical trials.

Ragweed (Ambrosia) pollen source inventory for Austria

This study improves the spatial coverage of top-down Ambrosia pollen source inventories for Europe by expanding the methodology to Austria, a country that is challenging in terms of topography and the distribution of ragweed plants. The inventory combines annual ragweed pollen counts from 19 pollen-monitoring stations in Austria (2004-2013), 657 geographical observations of Ambrosia plants, a Digital Elevation Model (DEM), local knowledge of ragweed ecology and CORINE land cover information from the source area. The highest mean annual ragweed pollen concentrations were generally recorded in the East of Austria where the highest densities of possible growth habitats for Ambrosia were situated. Approximately 99% of all observations of Ambrosia populations were below 745m. The European infection level varies from 0.1% at Freistadt in Northern Austria to 12.8% at Rosalia in Eastern Austria. More top-down Ambrosia pollen source inventories are required for other parts of Europe.

CAPSULE ABSTRACT

A method for constructing top-down pollen source inventories for invasive ragweed plants in Austria, a country that is challenging in terms of topography and ragweed distribution.

Personalized symptoms forecasting for pollen-induced allergic rhinitis sufferers

Hay fever is a pollen-induced allergic reaction that strongly affects the overall quality of life of many individuals. The disorder may vary in severity and symptoms depending on patient-specific factors such as genetic disposition, individual threshold of pollen concentration levels, medication, former immunotherapy, and others. Thus, information services that improve the quality of life of hay fever sufferers must address the needs of each individual separately. In this paper, we demonstrate the development of information services that offer personalized pollen-induced symptoms forecasts. The backbone of these services consists of data of allergic symptoms reported by the users of the Personal Hay Fever Diary system and pollen concentration levels (European Aeroallergen Network) in several sampling sites. Data were analyzed using computational intelligence methods, resulting in highly customizable forecasting models that offer personalized warnings to users of the Patient Hay Fever Diary system. The overall system performance for the pilot area (Vienna and Lower Austria) reached a correlation coefficient of r = 0.71 ± 0.17 (average ± standard deviation) in a sample of 219 users with major contribution to the Pollen Hay Fever Diary system and an overall performance of r = 0.66 ± 0.18 in a second sample of 393 users, with minor contribution to the system. These findings provide an example of combining data from different sources using advanced data engineering in order to develop innovative e-health services with the capacity to provide more direct and personalized information to allergic rhinitis sufferers.

The relationship between self-injurious behavior and self-disclosure in adolescents with eating disorders

PURPOSE

The aim of the current study is to examine the association between self disclosure and self-injurious behaviors among adolescent patients diagnosed with an eating disorder.

METHODS

Sixty three female patients who fulfilled the DSM-IV diagnostic criteria of eating disorders were included (i.e. anorexia, bulimia, binge eating disorder and eating disorders not otherwise specified). Participants' age ranged from 11.5 to 20 years (M = 15.42, SD = 1.82). Participants completed self- report questionnaires about eating disorders, self-disclosure, self-injurious behaviors (FASM) and depression (BDI-II) RESULTS: 82.5% of the sample endorsed severe self-injurious behaviors. A moderate negative relationship was found between general disclosure to parents and self-injurious behaviors indicating that patients who generally self-disclose to their parents (on different topics, apart from suicidal ideation) engage less frequently in self-injurious behaviors. In addition, the more patients self-disclose their suicidal ideation to others, the more they tend to self-injure.

CONCLUSION

Self-disclosure to parents on any topic may buffer against self-injurious behaviors and therefore it is important to work with adolescents suffering from eating disorders on effective self disclosure. In addition, self-disclosure about suicidal ideation to others by adolescents suffering from eating disorders should always be taken seriously, since it may be related to self-injurious behaviors.

Headache cessation by an educational intervention in grammar schools: a cluster randomized trial

BACKGROUND AND PURPOSE

Headache is a common health problem in adolescents. There are a number of risk factors for headache in adolescents that are amenable to intervention. The aim of the study was to assess the effectiveness of a low-level headache prevention programme in the classroom setting to prevent these risk factors.

METHODS

In all, 1674 students in 8th-10th grade at 12 grammar schools in greater Munich, Germany, were cluster randomized into intervention and control groups. A standardized 60-min prevention lesson focusing on preventable risk factors for headache (physical inactivity, coffee consumption, alcohol consumption and smoking) and providing instructions on stress management and neck and shoulder muscle relaxation exercises was given in a classroom setting. Seven months later, students were reassessed. The main outcome parameter was headache cessation. Logistic regression models with random effects for cluster and adjustment for baseline risk factors were calculated.

RESULTS

Nine hundred students (intervention group N = 450, control group N = 450) with headache at baseline and complete data for headache and confounders were included in the analysis. Headache cessation was observed in 9.78% of the control group compared with 16.22% in the intervention group (number needed to treat = 16). Accounting for cluster effects and confounders, the probability of headache cessation in the intervention group was 1.77 (95% confidence interval = [1.08; 2.90]) higher than in the control group. The effect was most pronounced in adolescents with tension-type headache: odds ratio = 2.11 (95% confidence interval = [1.15; 3.80]).

CONCLUSION

Our study demonstrates the effectiveness of a one-time, classroom-based headache prevention programme.

Psychosocial and medical aspects of older suicide completers in Israel: a 10-year survey

OBJECTIVES

The rate of completed suicide among the elderly continues to be the highest of any age group worldwide. The aim of the present study was to investigate the sociodemographic data, mental and physical health characteristics, and suicide methods of the elderly population who completed suicide in Israel.

METHODS

A national retrospective record-based case series study of consecutive elder (50 years or older) suicide completers who had undergone autopsy over a 10-year period was conducted.

RESULTS

Three hundred and fourteen consecutive records of suicide completers, 69.6% males, and mean age 64.7 were analyzed. The largest group (38%) emigrated from the Former Soviet Union and 19% emigrated from East Europe. Immigrants from East Europe committed suicide at an older age. Hanging was the predominant suicide method. Jumping from height increased more than threefold in the ‘old-old’(older than 75 years) group. Hanging and firearms were more frequently used by males. Females were more likely to employ poisoning and suffocation. A significant minority (30%) had been diagnosed as suffering from psychiatric morbidity. Most common diagnoses were depression and alcohol abuse or dependence. Physical disorders (mainly cardiovascular disease and malignancy) were present in 27% of cases. Subjects with psychiatric illness were more likely to complete suicide at a younger age compared with subjects with physical illness.

CONCLUSIONS

Findings of male predominance, psychiatric morbidity, and physical illness are consistent with previously published studies. Immigrants from East Europe completed suicide at an older age and the older victims had used more lethal methods of suicide.

Geographic and temporal variations in pollen exposure across Europe

BACKGROUND

The EC-funded EuroPrevall project examined the prevalence of food allergy across Europe. A well-established factor in the occurrence of food allergy is primary sensitization to pollen.

OBJECTIVE

To analyse geographic and temporal variations in pollen exposure, allowing the investigation of how these variations influence the prevalence and incidence of food allergies across Europe.

METHODS

Airborne pollen data for two decades (1990-2009) were obtained from 13 monitoring sites located as close as possible to the EuroPrevall survey centres. Start dates, intensity and duration of Betulaceae, Oleaceae, Poaceae and Asteraceae pollen seasons were examined. Mean, slope of the regression, probability level (P) and dominant taxa (%) were calculated. Trends were considered significant at P < 0.05.

RESULTS

On a European scale, Betulaceae, in particular Betula, is the most dominant pollen exposure, two folds higher than to Poaceae, and greater than five folds higher than to Oleaceae and Asteraceae. Only in Reykjavik, Madrid and Derby was Poaceae the dominant pollen, as was Oleaceae in Thessaloniki. Weed pollen (Asteraceae) was never dominant, exposure accounted for >10% of total pollen exposure only in Siauliai (Artemisia) and Legnano (Ambrosia). Consistent trends towards changing intensity or duration of exposure were not observed, possibly with the exception of (not significant) decreased exposure to Artemisia and increased exposure to Ambrosia.

CONCLUSIONS

This is the first comprehensive study quantifying exposure to the major allergenic pollen families Betulaceae, Oleaceae, Poaceae and Asteraceae across Europe. These data can now be used for studies into patterns of sensitization and allergy to pollen and foods.

[Children and Adolescents--Preventive Activities are Effective]

Health-related attitudes and behaviour are working already in the first years of life. Approaches of prevention for children and adolescents exist from structured programmes to promote healthy behaviour and to strengthen life skills through the support of parents to the qualification of professionals for the promotion of childhood resources. An essential starting point is the design of living conditions in which children and young people spend a lot of their time. An important goal of the BMBF-Förderschwerpunkt "Prevention Research" was the knowledge about which programmes, policies and approaches are effective and justify a transfer into practice. On looking back on the projects, some factors for the effectiveness of the measures could be identified: the presence of a reason, context reference, programme offerings and activation of all actors. The research projects also provide evidence of an increase in knowledge of effective evaluation since supply onset, although a binding standard of evaluation, the understanding of relevant outcome measures and other aspects are still lacking.

Mastitis severity induced by two Streptococcus uberis strains is reflected by the mammary immune response in vitro

Streptococcus uberis is the most common environmental mastitis pathogen causing udder inflammations of different severities in dairy cows. The aim of the study was to investigate if the different clinical outcome of mastitis induced by different strains of S. uberis can be reflected in the mammary immune response. Mammary epithelial cells and somatic milk cells were treated with heat inactivated and living S. uberis of strain A and strain B in vitro. Strain A was repeatedly isolated from a chronically infected quarter during 8 months, and persisted in the quarter despite antibiotic treatment. Strain B caused an acute clinical mastitis and was not further isolated after a single antibiotic treatment. Treatment with Strain B induced a more pronounced increase of mRNA-expression of various immune factors (interleukin-8, interleukin-1beta, RANTES, and lactoferrin) in mammary epithelial cells than strain A. In contrast to mammary epithelial cells the response of removed somatic milk cells showed no differences between the stimulation with two S. uberis strains. Tumor necrosis factor-alpha mRNA expression was not differently induced by the two strains. In conclusion, the characteristics of different severities of mastitis that are induced by different S. uberis strains in vivo can also be reflected at the level of the immune response of the mammary gland in vitro.

Airborne olive pollen counts are not representative of exposure to the major olive allergen Ole e 1

Pollen is routinely monitored, but it is unknown whether pollen counts represent allergen exposure. We therefore simultaneously determined olive pollen and Ole e 1 in ambient air in Córdoba, Spain, and Évora, Portugal, using Hirst-type traps for pollen and high-volume cascade impactors for allergen. Pollen from different days released 12-fold different amounts of Ole e 1 per pollen (both locations P < 0.001). Average allergen release from pollen (pollen potency) was much higher in Córdoba (3.9 pg Ole e 1/pollen) than in Évora (0.8 pg Ole e 1/pollen, P = 0.004). Indeed, yearly olive pollen counts in Córdoba were 2.4 times higher than in Évora, but Ole e 1 concentrations were 7.6 times higher. When modeling the origin of the pollen, >40% of Ole e 1 exposure in Évora was explained by high-potency pollen originating from the south of Spain. Thus, olive pollen can vary substantially in allergen release, even though they are morphologically identical.

Effectiveness of reducing the risk of eating-related problems using the German school-based intervention program, "Torera", for preadolescent boys and girls

Representative surveys indicate that eating disorders are an increasing problem, especially among (pre)adolescents. We assessed the effects of a German school-based primary prevention program ("Torera") for seventh graders. Torera especially relates to pathological eating behavior in the realm of bulimia nervosa or binge eating disorder. The program is built upon two previously evaluated modules for sixth graders with a gender-specific adaption. The coeducational intervention involves nine manual-guided lessons touching a wide range of eating-related problems. Twenty-two Thuringian secondary schools (n = 256 boys and 277 girls, aged 11-13 years at baseline) participated in a trial with 2 control groups (untreated and pretreated) with pre-post assessment. Primary outcomes were conspicuous eating behavior and body self-esteem, measured by standardized questionnaires (SCOFF, EAT-26D, and FBeK). Girls and students at risk showed significant improvement with small (d = 0.35) to medium (d = 0.66) effect sizes on eating behavior, significantly mediated by body self-esteem. Boys only improved with respect to eating attitudes, revealing a small effect size (d = 0.35). With relatively low implementation costs (about <euro>2.50 per student), Torera provides an efficient model for reducing risky eating behavior and strengthening body self-esteem without negative side effects. To improve the effectiveness of the intervention, further research efforts focusing on at-risk groups (secondary prevention) and structural actions for prevention (e.g., offering healthy school catering) are needed.

Magnetic stimulation intensity modulates motor inhibition

Repetitive transcranial magnetic stimulation (rTMS) is a standard tool in neuroscience research and therapy. Here we study one rTMS property that has not received adequate attention, the interaction of subthreshold intensity stimulation and low frequencies. We applied 1Hz rTMS over the motor cortex at three intensities, 40%, 80% and 100% of the resting motor threshold (rMT), and measured cortical excitability before and after the stimulation sessions. When comparing motor evoked potential (MEP) measured from the abductor pollicis brevis (APB) muscle before and after rTMS stimulation, we found that low intensity (40% MT) stimulation significantly decreased MEP magnitude, some smaller (non-significant) inhibition was found for the 80% MT intensity and increased MEP was found for the high intensity (100% MT) stimulation. Our results indicate that when explaining the input-output relationship of motor cortex induced activation as an intensity-dependent function, there might be a need to split it into separate functions associated with separate processes mediated by different cell types such as interneurons, pyramidal neurons and others.

Screening of disordered eating in 12 year old girls and boys: Psychometric analysis of the German versions of SCOFF and EAT-26

To detect eating disorders and risky eating behaviour in early stages, screening tests are used. In order to examine as many adolescents as possible, these tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D) and the German version of the SCOFF test (which contains only five Yes-no questions) in a sample of 425 twelve year old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of rtt = .73 and a maximum accuracy of 82% (area under the ROC curve). In reference to the EAT-26D (20 point cut-off) the sensitivity of the SCOFF was 78%, specificity 75%, positive predictive value 28%, and the negative predictive value, which is more relevant for screenings, was 96%. The construct validity reached r = .52.

Biocomplexity in mangrove ecosystems

Mangroves are an ecological assemblage of trees and shrubs adapted to grow in intertidal environments along tropical coasts. Despite repeated demonstration of their economic and societal value, more than 50% of the world's mangroves have been destroyed, 35% in the past two decades to aquaculture and coastal development, altered hydrology, sea-level rise, and nutrient overenrichment. Variations in the structure and function of mangrove ecosystems have generally been described solely on the basis of a hierarchical classification of the physical characteristics of the intertidal environment, including climate, geomorphology, topography, and hydrology. Here, we use the concept of emergent properties at multiple levels within a hierarchical framework to review how the interplay between specialized adaptations and extreme trait plasticity that characterizes mangroves and intertidal environments gives rise to the biocomplexity that distinguishes mangrove ecosystems. The traits that allow mangroves to tolerate variable salinity, flooding, and nutrient availability influence ecosystem processes and ultimately the services they provide. We conclude that an integrated research strategy using emergent properties in empirical and theoretical studies provides a holistic approach for understanding and managing mangrove ecosystems.

Perfluorinated and other persistent halogenated organic compounds in European shag (Phalacrocorax aristotelis) and common eider (Somateria mollissima) from Norway: a suburban to remote pollutant gradient

Samples of two marine bird species, European shag (Phalacrocorax aristotelis) and common eider (Somateria mollissima) sampled at a remote coastal site in Norway were analysed for POPs and PFCs. Additionally samples of common eider were analysed from two other locations in Norway, representing a gradient from "densely populated" to "remote". The variety, concentration and distribution of lipophilic POPs in comparison to PFCs were investigated. PCBs were the dominating group of contaminants in the analysed egg samples. Shag eggs had median sum PCBs levels of 4,580 ng/g l.w. in 2004. Six different PBDE congeners could be detected in the shag eggs. BDE 47 and 100 were the main contributors with 24 and 27 ng/g l.w. respectively, sum PBDEs was 90 ng/g l.w. Relatively high concentrations of chlordanes were found with a total sum of 903 ng/g l.w. Of other OCs, toxaphene 26 and 52 together (sum 657 ng/g l.w.) and HCB (165 ng/g l.w.) were contributing majorly to the egg burden. Sum HCHs were low; only 54 ng/g l.w. PFOS was the main PFC in egg, plasma and liver samples. Similar median levels of 29, 32 and 27 ng/g w.w. were observed. PFOSA, PFH x S, and PFDcA were observed additionally in all shag samples at minor concentrations with the exception of elevated levels observed in liver for PFOSA and PFDcA with median levels of 7.6 and 7.9 ng/g w.w., respectively. In common eider eggs, the POP concentrations decreased up to 1/8th along the sampled spatial gradient from suburban to remote. Of the 9 detected PFCs, PFOS dominated all samples by one order of magnitude, followed by PFOA. Sum PFC concentrations were twice as high at the two fjord sites compared to the remote site. Shorter chained PFCAs like PFOA and PFNA could be detected in the eider eggs whilst being absent in shag eggs.