Subcutaneous allergen immunotherapy for asthma: A randomized, double-blind, placebo-controlled study with a standardized Blomia tropicalis vaccine.

BACKGROUND: Sensitization to Blomia tropicalis (Bt) is very frequent in the tropics, and particularly in Cuba, being a significant cause of allergic asthma. Allergen immunotherapy (AIT) with Bt can be a therapeutic option, however, placebo-controlled clinical trials have not been reported. OBJECTIVE: To assess the therapeutic effect and safety of AIT for asthma using a standardized allergen vaccine of B. tropicalis by subcutaneous route, in allergic asthmatic patients exposed and sensitized to this mite species. METHODS: A double-blind, placebo-controlled Phase II trial was conducted in 35 adults (18 with treatment and 17 with placebo), with mild to moderate asthma, predominantly sensitized to Bt. AIT was administered subcutaneously in increasing doses from 4 to 6000 Biological Units using a locally manufactured standardized extract (BIOCEN, Cuba). Patient assessment was performed using symptom-medication score (SMS), peak expiratory flow and skin reactivity relative to Histamine as measured by skin prick test (SPT). RESULTS: The 12-month treatment achieved a significant (p < 0.001) decrease of SMS. Symptom score showed only 41% (CI: 26-61) of placebo values, whereas medication was 34.5% (22.4%-63.3%). Treatment was regarded clinically effective in 67% of patients (OR 32; 95%CI: 17 to 102). The effect size on symptoms and medication was higher than has been reported with equivalent allergen dosages of D. pteronyssinus and D. siboney in Cuban asthmatic patients. Skin reactivity to Bt was also significantly reduced (p = 0.0001), increasing 148-fold the allergen threshold to elicit a positive skin test. This desensitization effect was specific to Bt and did not modify the reactivity to Dermatophagoides. The change of specific skin reactivity was significantly (p < 0.05) correlated to clinical improvement. All adverse events were local with a frequency of 2.4% of injections. CONCLUSIONS: Subcutaneous AIT with Blomia tropicalis was effective and safe in asthmatic adults exposed and sensitized to this mite species in a tropical environment. TRIAL REGISTRATION: Cuban Public Registry of Clinical Trials: RPCEC00000026 (WHO International Clinical Trial Registry Platform ICTRP).

Reflecting on Behavioral Spillover in Context: How Do Behavioral Motivations and Awareness Catalyze Other Environmentally Responsible Actions in Brazil, China, and Denmark?

Responding to serious environmental problems, requires urgent and fundamental shifts in our day-to-day lifestyles. This paper employs a qualitative, cross-cultural approach to explore people's subjective self-reflections on their experiences of pro-environmental behavioral spillover in three countries; Brazil, China, and Denmark. Behavioral spillover is an appealing yet elusive phenomenon, but offers a potential way of encouraging wider, voluntary lifestyle shifts beyond the scope of single behavior change interventions. Behavioral spillover theory proposes that engaging in one pro-environmental action can catalyze the performance of others. To date, evidence for the phenomenon has been mixed, and the causal processes governing relationships between behaviors appear complex, inconsistent and only partly understood. This paper addresses a gap in the literature by investigating accounts of behavioral spillover in three diverse cultural settings using qualitative semi-structured interviews. The analysis shows that while around half of participants overall who were questioned recalled spillover effects, the other half had not consciously experienced spillover. There were few significant differences across cultures, though some forms of spillover effects were reported more in some cultures than others. More environmentally engaged participants across all three countries were significantly more likely to experience spillover than those who were less engaged. Accounts of within-domain spillovers were most commonly reported, mainly comprising waste, resource conservation and consumption-related actions. Accounts of between-domain spillover were very rare. Recollection of contextual and interpersonal spillover effects also emerged from the interviews. Our findings suggest that more conscious behavioral spillover pathways may be limited to those with pre-existing environmental values. Behavioral spillover may comprise multiple pathways incorporating conscious and unconscious processes. We conclude that targeting behavioral catalysts that generate more socially diffuse spillover effects could offer more potential than conventional spillover involving a single individual.

The international occurrence of the acquired immunodeficiency syndrome.

Through December 1984, 9932 cases of the acquired immunodeficiency syndrome have been reported, mainly from North and South America and Europe; 85% of these cases occurred in the United States. Haiti and the United States have the highest incidence rates, 59 and 36 per million population, respectively. Rates in the United States range from 0.3 (beginning of 1981) to 10.4 (end of 1984). Brazil, Canada, Denmark, Switzerland, France, West Germany, the United Kingdom, and the Netherlands show a slower increase. Homosexual men and intravenous drug users are still the main risk groups in the United States and Europe. The disease is prevalent in heterosexual Haitians and Africans whether they live in their own countries or abroad. Cases of the syndrome have been identified in Zaire, Rwanda, Zambia, and Uganda, but its full extent is not yet known. Consistent with the general history of epidemics, the appearance of geographically separated sites of incidence of the syndrome could be linked to population migrations; however no evidence has been found to identify an index location.

A reassessment of world population trends.

This reassessment is limited to observations concerning trends in mortality and fertility and concerning longrun prospects for population growth. Recorded changes in mortality are compared with 3 projections made many years ago. Projections of European mortality made in 1941-42 understated by a wide margin the actual increase in expectation of life because of unforeseen technological changes in the prevention and cure of fatal disease. On the other hand, a projection made in 1955 for India, foreseeing a rapid rise in the 1950s and slower progress later on because of the exhaustion of the easier gains, appears to have been accurate and also to depict the prospects in other populations of relatively high mortality and low income. A different projection of life expectancy in Mexico was also quite close to actual changes in Mexican mortality; it was based on a universal curve constructed to represent how life expectancy rises, increasing ever more slowly as it approaches an upper limit. This curve (1 for each sex), constructed for projection of Mexican mortality, is employed as a standard of comparison for mortality changes in many countries. A number have followed the standard for females very closely for more than 3 decades; in developed countries, male life expectancy has generally fallen short of the standard. The almost universal low fertility in developed countries contrasts with the great diversity of levels and trends of fertility in developing countries, some of which retain undiminished high fertility and others of which have recently attained rates of childbearing as low as in the developed areas. Instances of surprisingly little change and surprisingly rapid change in fertility are described. In the future, growth of populations of developed countries will probably be slight; the future rate of increase in the developing areas depends on the unpredictable timing and pace of childbearing reduction in populations where fertility remains high. In the long run, world population growth may resume its typical pattern of moderate growth interrupted by catastrophic setbacks.

News, views, trends: a world-wide survey of recent developments, fresh ideas and production plans.

PIP: Recent developments in the tobacco industry in several countries are described: 1) in the USSR the policy is not to encourage smoking but to produce pleasant cigarettes which are as harmless as possible; 2) in the US, a survey shows that in 1975 not more than 12.4% of men over age 21 smoked a pipe; 3) in Britain a new cigarette tax structure will cripple the cigarette industry's coupon scheme of which manufacturers make great use to secure brand loyalty; 4) in the Philippines a proposal to print a health warning on cigarette packets and in advertisements might affect cigarette and tobacco taxes, which contribute 47% of government income; 5) in the Netherlands health warnings will be printed on cigarette packs, 6) in Austria there has been an increase of 4.2% in cigarette smoking since late 1975; 7) in Poland anti-smoking officials have proposed that the name of the popular "Sport" cigarette be changed; 8) in Indonesia there has been a recovery in kretek sales; 9) in Denmark cigarette consumption increased 6% from 1974; and 10) in western Europe it has been shown that up to 99% of grocery stores in Ireland sell tobacco products, 91% in Britain, 30% in Austria, 17% in Spain, and 7% in Italy.^ieng

[Family planning. A survey of United Nations around the world]. / Le planning familial. Une enquete des Nations Unies a travers le monde.

PIP: Responses to the second worldwide survey of 80 nations on their population policy can be divided into 3 categories. First are countries with large official programs of family planning in existence: Egypt, Kenya, Tunisia, Barbados, Colombia, Panama, Trinidad and Tobago, China, India, Iran, Japan, Nepal, Pakistan, Philippines, Republic of Viet-nam, Singapore, Sri Lanka, Thailand, Turkey, Denmark, Netherlands, United Kingdom, Yugoslavia, Canada, and Fiji. Madagascar and New Zealand are starting programs. The second category is countries that encourage private family planning programs: Tanzania, Mexico, Israel, Cambodia, Bahrain, Jordan, Laos, Syria, Austria, France, West Germany, Finland, and Norway. Third are listed countries that do not officially support, or that forbid contraception: Gabon, Malawi, Zambia, Greece, Italy, and Spain. Thus Asia and North Africa have the most ambitious programs, but Europe and North America practice contraception universally.^ieng

The pill in figures and facts.

PIP: A review of the use of oral contraceptives from 1956-1966 is presented for the U.S. and several European and Latin American countries. In 1969 an estimated 9,600,000 to 10,700,000 women in the world were pill users. Estimates for the number in 1985 vary from 20,000,000 to 40,000,000. However estimates are difficult because of the improvements in fertility control that are likely to occur in the future.^ieng