Assessment of endogenous allergenicity of genetically modified plants exemplified by soybean - Where do we stand?

According to EU regulation, genetically modified (GM) plants considered to be allergenic have to be assessed concerning their endogenous allergens before placement on the EU market, in line with the international standards described in Codex Alimentarius. Under such premises, a quantitative relevant increase in allergens might occur in GM plants as an unintended effect compared with conventionally produced crops, which could pose a risk to consumers. Currently, data showing a connection between dose and allergic sensitisation are scarce since the pathophysiological mechanisms of sensitisation are insufficiently understood. In contrast, data on population dose-distribution relationships acquired by oral food challenge are available showing a connection between quantity of allergenic protein consumed and the population of allergic individuals experiencing reactions. Soybean is currently the only recognised allergenic GM food by law for which EFSA has received applications and was therefore taken as an example for defining an assessment strategy. Identification of potential allergens, methodology for quantification as well as risk assessment considerations, are discussed. A strategy is proposed for the identification, assessment and evaluation of potential hazards/risks concerning endogenous allergenicity in food derived from plants developed by biotechnology. This approach could be expanded to other allergenic foods in the future, whenever required.

Demographic, health and lifestyle factors associated with dental service attendance by young adults.

BACKGROUND: The aim of this study was to describe the demographic and health and lifestyle factors associated with dental service attendance in the previous 12 months by young Australian adults (18-24 years). METHODS: Population-based data from the 2001 Australian National Health Survey were analysed. Proportions and single associations between variables of interest and dental service attendance were calculated. A logistic regression analysis using significant single association variables was then conducted. RESULTS: Overall, 41 per cent of young adults in this study had visited a dental professional in the previous 12 months. Females, those in cities, those with private insurance, those who spoke languages other than English, those in the highest socioeconomic group and those with healthy behaviours were subgroups most likely to have visited a dental professional. With logistic regression, factors found to be associated with dental services attendance were being female, having private health insurance and low alcohol consumption. CONCLUSIONS: In this study, the proportion of young adults who had visited a dental professional in the previous 12 months was only 41 per cent. It is therefore suggested that oral health policy and promotion activities be encouraged for this group, paying attention to young adults in groups with low attendance.

Allergenicity assessment of apple cultivars: hurdles in quantifying labile fruit allergens.

BACKGROUND: Assessment of allergenicity of foods is important for allergic consumers and regulators. Immunoassays to measure major food allergens are widely applied, often giving variable results. Using the major apple allergen Mal d 1 as a model, we aimed to establish at the molecular level why different immunoassays for assessing allergenicity of apple cultivars produce conflicting outcomes. METHODS: Mal d 1 was measured in 53 cultivars from Italy and 35 from The Netherlands, using four different immunoassays. Purified Mal d 1 standards were molecularly characterized by size-exclusion chromatography (SEC) and mass spectrometry (MS). RESULTS: Three immunoassays using an identical standard gave similar results. Minor differences in sample preparation already resulted in significant loss of allergenicity. The fourth assay, using a different Mal d 1 standard, gave 10- to 100-fold lower outcomes. By SEC, this standard was shown to be almost fully aggregated. This aggregation was accompanied by a decrease of the mass of the Mal d 1 molecule by approximately 1 kDa as analyzed by MS. The deviating immunoassay was shown to selectively recognize this aggregated form of Mal d 1, whereas the other three assays, including the one based on IgE antibody recognition, preferentially bound non-aggregated allergen. CONCLUSIONS: Variable and poorly controllable major allergen modification in both extracts and standards hamper accurate allergenicity assessments of fruits.

A framework for measuring costs to society of IgE-mediated food allergy.

Both immunoglobulin E (IgE)-mediated food allergy and food intolerance can lead to many changes in personal behaviour and health care resource use which have important economic consequences. These costs will impact directly, indirectly and intangibly on both individuals and society in general. It is important to measure the cost of illness (COI) of food allergy as a first step in developing and evaluating measures to reduce and control the burden of illness. This paper outlines a framework for assessing COI of food allergy from different viewpoints. It offers a structure for identifying the different cost impacts on allergic and nonallergic consumers, food producers and society as a whole, and for scoping, measurement and valuation of relevant costs. Within this structure, the existing literature is reviewed. This review illustrates the lack of information and clear methodology for assessing costs of food allergy. The paper concludes that there is a need for a more structured research programme to generate data essential for future evaluations of procedures and technologies for the diagnosis, treatment and management of food allergy.

Report from the CDC. Use of preventive health services by Hispanic/Latino women in two urban communities: Atlanta, Georgia and Miami, Florida, 2000 and 2001.

PURPOSE: During the 1990s, a 58% increase in the Hispanic/Latino population, fueled by the century's largest immigration wave and the highest fertility of any group, resulted in Hispanics becoming the largest U. S. minority group. To assess use of preventive services by Hispanics in Atlanta, Georgia, the largest Hispanic new destination, and Miami, Florida, the largest established Hispanic community in the Southeast, survey data were analyzed. METHODS: Miami-Ft. Lauderdale and Atlanta metropolitan area data from the 2000 National Health Interview Survey (NHIS) and from anonymous surveys conducted at health festivals in Miami and Atlanta in 2001 were analyzed. RESULTS: Female non-Hispanic white and black NHIS respondents were more likely than Hispanic counterparts to report annual household income >$20,000 (77.3%, 70.8% vs. 67.7%), usual source of healthcare (61.5%, 56.4% vs. 50.2%), or ever having had Pap screening (88.8%, 86.7% vs. 80.7%) or oral contraceptive use (55.7%, 59.7% vs. 33.7%). Miami-Ft. Lauderdale Hispanics were less likely than Atlanta respondents to be monolingual Spanish speakers, to lack usual source of healthcare, or to have less than 12 years of education. Of 295 female health festival respondents, the 160 Miami participants were more likely than Atlanta participants to have health insurance, monthly income >$1000, and prior Pap screening (p < 0.01) but less likely to have used contraception (p = 0.07). Most Hispanics felt they had inadequate healthcare; 15.0% reported being denied healthcare because of inability to pay. CONCLUSIONS: Low income, uninsured status, and language barriers were associated with lower use of preventive services among Hispanics in these Southeastern communities, particularly Atlanta, a new destination.

Patient cost-benefits of realtime teledermatology--a comparison of data from Northern Ireland and New Zealand.

As part of a randomized controlled trial of the costs and benefits of realtime teledermatology in comparison with conventional face-to-face appointments, patients were asked to complete a questionnaire at the end of their consultation. One hundred and nine patients took part in an initial teledermatology consultation and 94 in a face-to-face consultation. The proportion of patients followed up by the dermatologist was almost the same after teledermatology (24%) as after a hospital appointment (26%) and for similar reasons. Two hundred and three questionnaires were completed after the first visit and a further 20 after subsequent visits. Patients seen by teledermatology at their own health centre travelled an average of 12 km, whereas those who attended a conventional clinic travelled an average of 271 km. The telemedicine group spent an average of 51 min attending the appointment compared with 4.3 h for those seen at the hospital. The results of the present study, as in a similar study conducted in Northern Ireland, show that the economic benefits of teledermatology favour the patient rather than the health-care system.

Longitudinal tracking and retention in a school-based study on adolescent smoking: costs, variables, and smoking status.

Methods used to track a cohort of Grade 6 students through Grades 8 and 11, and costs involved for survey completion in school and by mail for ever and never smokers from the original group are detailed. At baseline, 1,598 students in Scarborough, Canada, completed a questionnaire on smoking, drinking, and health, and again in Grade 8 (N = 1,543/1,598) and Grade 11 (N = 1,454/1,598). In Grades 8 and 11, tracking and administering the questionnaire was more costly per participant when the survey was administered by mail than in school. Average completion costs were highest for Grade 11 students who used tobacco at baseline ($52.44). Students categorized as ever smokers in Grade 6 were harder to locate at each phase of testing, which suggests that this group should be identified at baseline so that closer tracking procedures may be employed between data collection points.

In search of the wage-labour/service contract: new evidence on the validity of the Goldthorpe class schema.

In this paper we examine new empirical evidence on the coherence and magnitude of the main classes in the Goldthorpe class schema. Particular attention is paid to issues that have recently been a source of academic dispute: the coherence and size of the service class and the distinction between the service class and intermediate classes. Using recently available British data collected by the Office for National Statistics we examine: (i) the extent to which measures of class-relevant job characteristics are empirically discriminated by the categories of the schema; (ii) the structure of a 'contract type' dimension of employment relations conceived of as a categorical latent variable; and (iii) the association between this latent variable and both the Goldthorpe class schema and a related measure socio-economic group (SEG). We find that the data are consistent with the existence of a three category latent 'contract type' variable largely corresponding to the notions of service, intermediate and wage-labour contracts explicit in discussions of the theoretical rationale for the Goldthorpe schema. We further find a substantial degree of fit between the latent 'contract types' and the schema. However, the service class fault line appears to lie within class I and II of the schema rather than between them and the intermediate classes which suggests a revised, smaller service class would better capture the reality of the contemporary British occupational structure.

Patient retention issues in Medicare risk-contracting HMOs.

Positive patient-physician interaction is essential to a successful practice. Positive patient-practice experiences may also result in decreased medical liability costs. However, most medical practices are not organized according to this mind-set. As managed care physicians in either closely linked medical groups or loose affiliations consider signing Medicare risk contracts, the importance of a "patient-focused" orientation is critical for success. Measured patient retention is the positive outcome of such efforts.

Evaluation of an evolutionary model of self-preservation and self-destruction.

According to deCatanzaro's mathematical model of self-preservation and self-destruction, staying alive actually may reduce inclusive fitness for an individual who is low in reproductive potential and, at the same time, poses such a burden to close kin that it costs them opportunities for reproduction. Predictions generated from this model were tested using 175 university students as subjects and variables constructed from a 164-item questionnaire. The criterion variables were separate measures of depression, hopelessness, and suicide ideation and behavior. The predictor variables derived from the model were separate measures of reproductive potential of the individual, the individual's perceived benefit or cost to kin, and reproductive potential of the individual's kin. As predicted, there were negative and significant bivariate correlations between each of the model-generated predictor variables and one or more of the criterion variables. Multiple regression analyses showed that benefit to kin was the best predictor of both depression and hopelessness. Discriminant analysis showed that reproductive potential of kin significantly differentiated suicide attempters from nonattempters. Overall, our results support and extend deCatanzaro's model and empirical findings.

Financing long-term care in Canada.

Financial policies relating to long-term care in Canada are changing rapidly in response to demands for health care reform. This chapter focuses on the financial structure of institutional care, primarily nursing homes, in the western provinces of Alberta and British Columbia. Community-based long-term care is discussed briefly.

Canadian beef quality audit.

A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) was observed on 34% of the cattle. Bruises were found on 78% of the carcasses, 81% of which were minor in severity. Fifteen percent of the bruises were located on the round, 29% on the loin, 40% on the rib, 16% on the chuck, and 0.02% on the brisket. Grubs were observed in 0.02% of the steers, and injection sites were observed in 1.3% of whole hanging carcasses. Seventy percent of the livers were passed for human food and 14% for pet food; 16% were condemned. Approximately 71% of the liver condemnations were due to liver abscesses. Four percent of the heads, 6% of the tongues, and 0.2% of whole carcasses were condemned. The pregnancy rate in female cattle was approximately 6.7%. The average hot carcass weight was 357 kg (s = 40) in steers, 325 kg (s = 41) in heifers, 305 kg (s = 53) in cows, 388 kg (s = 62) in virgin bulls and 340 kg (s = 39) in mature bulls. The average ribeye area in all cattle was 84 cm2 (s = 12); range 29 cm2 to 128 cm2. Grade fat was highly variable and averaged 9 mm (s = 4) for steers and heifers, 6 mm (s = 6) for cows, 5 mm (s = 1) for virgin bulls, and 4 mm (s = 0.5) for mature bulls. The average lean meat yield was 59.7% in cattle (s = 3.4); range 39% to 67%. One percent of the carcasses were devoid of marbling, 1% were dark cutters, and 0.05% of the steer carcasses were staggy. Six percent of the carcasses had poor conformation, 3.7% were underfinished, and 0.7% were overfinished. Yellow fat was observed in 4% of the carcasses; 10% of carcasses were aged. Based on January 1996 prices, the economic analysis showed that the Canadian beef industry lost $70.52 per head or $189.6 million annually from quality nonconformities. Methods identified to reduce these nonconformities included improvements in management, animal identification, handling, genetic selection, marketing, grading, and information transfer.

Fallon ER facilitator program: managed care in the ER setting.

Managed care systems have traditionally found ER management issues difficult to address. Patients view these facilities as points of consistent, easy, and reliable care. Providers see these facilities as necessary off load points from busy practices for problems whose intensity or complexity would overwhelm their office work flow. Emergency Department physicians understand their roles as nondiscriminate passive recipients of all patient flow through their facilities. These same providers also recognize a huge liability potential for both missed diagnosis and for perceived inadequate/unsafe treatment plans such as non-hospitalization when hospitalization was needed.

Cervical cancer screening: are the 1989 recommendations still valid? National Workshop on Screening for Cancer of the Cervix.

Although screening for cervical cancer has been shown to be effective in reducing the morbidity and mortality associated with this disease, and despite many attempts to encourage the development of provincial programs, as of 1995 no province had a comprehensive screening program for cervical cancer. Participants at the Interchange '95 workshop, held in Ottawa in November 1995, reviewed the recommendations of the 1989 National Workshop on Screening for Cancer of the Cervix and identified factors that have impeded their implementation. Participants discussed the need for comprehensive information systems, quality control and strategies to increase recruitment of unscreened and underscreened women. They concluded that the formation of a Cervical Cancer Prevention Network involving key stakeholders will facilitate the development and implementation of provincial programs to ensure optimal screening. They agreed that, in the interim, recommendations for practising physicians should remain as they were following the 1989 workshop.

Management of SNF beds in a group model HMO.

The appropriate use of alternatives to the acute care hospital is an essential component of the HMO's ability to manage utilization. The Skilled Nursing Facility (SNF) can be a particularly useful and flexible alternative. The present article describes how Fallon Community Health Plan, a 130,000-member group model HMO that includes a 16,000-member Medicare risk contract known as Senior Plan, integrates SNFs into its overall delivery of patient care. The article discusses the types of patients admitted, reasons for admission, types of services provided, and outcomes. The article also discusses the continuing evolution of the HMO's use of the SNF in patient care management.

Homeless women with minor children in the Detroit metropolitan area.

Eighty-seven homeless families served by the emergency shelter of the Coalition on Temporary Shelter in Detroit during the first quarter of 1987 were studies through a review of admission data. Most of the families were black and contained an adult female with one or two minor children. Most of the mothers were young, did not have a high school diploma, and had no income. Some had histories of psychiatric disorders or substance abuse. Many had been in a dependent living situation before becoming homeless. Children accounted for more than one-fourth of admissions during the study period. Policies should address prevention of homelessness through income support programs, provision of low-income housing, basic living skill training programs, and mental health service delivery. When available resources fail in prevention, programming should address the effects of homelessness on children, because these effects perpetuate a cycle that will increase the homeless population in future generations.

Hemodynamic response to treadmill exercise in normal volunteers: an assessment by Doppler ultrasonic measurement of ascending aortic blood velocity and acceleration.

Accurate assessment of ascending aortic blood velocity indices and reproducibility of a Doppler ultrasonic system during exercise were determined; the Doppler technique was then used to assess the effects of age, sex, and beta blockade on exercise hemodynamics. Doppler-determined velocity correlated well with an invasive electromagnetic system. Reproducibility of Doppler variables during three exercise tests was high (coefficient of variation less than 10%) and did not deteriorate appreciably with exercise. Peak velocity (PV) and maximum acceleration (MA) were inversely related to age, the relationship being more significant during exercise, whereas the systolic velocity integral showed no such relationship either at rest or during exercise. Doppler variables showed no difference between sexes, except at high levels of exercise. Beta blockade markedly attenuated the exercise response as shown by significant decreases in both MA and PV during exercise. The Doppler velocity data presented in this study provide a reference against which previously documented changes in exercising ischemic patients can be better related.

An analysis of different techniques for distal hypospadias repair: the price of perfection.

We discuss the risks of total surgical correction of distal hypospadias with chordee, review 42 such cases and analyze 4 common surgical procedures that were used. The over-all complication rate was 16.6 per cent (7 of 42), with 9.5 per cent (4 of 42) of the cases requiring addition urethral reconstruction. All complications occurred following procedures designed to extend the urethral meatus to the tip of the glans (Horton-Devine 5 of 15 and Ombrédanne 2 of 8). In contrast, no complications occurred following urethral advancement or Allen-Spence repairs (0 of 19). The physician and family should be aware of the increased risk attendant with total anatomical urethral correction in contrast to less extensive surgery, which gives an excellent functional result with minimal risk.