Type C botulism due to toxic feed affecting 52,000 farmed foxes and minks in Finland

The largest reported outbreak of type C botulism in fur production animals is described. Epidemiological investigation of 117 out of 157 (response rate, 74.5%) farms revealed that 44,130 animals died or were euthanized, while 8,033 animals with milder symptoms recovered. The overall death rate in all animals at risk was 21.7%. The death rates were significantly higher in blue and shadow foxes (24.2 and 27.8%, respectively) than in silver and blue silver foxes and minks (below 4%). All minks had been immunized against botulinum toxin type C. Deaths were associated with feed manufactured by a local processor, 83 of whose customer farms (70.9%) reported dead or sick animals. Five feedlots out of 19 delivered to the farms on the day preceding the onset of the outbreak (day 2) were associated with a death rate higher than 40%. These feedlots consisted of fresh feed processed on day 2 and feed processed 1 day earlier (day 1). In laboratory analysis, the day 2 feed contained botulinum toxin type C (>600 minimum lethal doses/g), while the day 1 feed did not contain toxin. Toxin was not detected in feed raw-material samples. Clostridium botulinum type C was detected by PCR in some feed components and in feed. However, as the feed temperature was continuously 8 degrees C or below and the pH was continuously 5.6 or below according to the manufacturer, it seems unlikely that spore germination and toxin formation occurred during overnight storage. Hence, the events leading to toxin formation were not determined.     

C3c and C3d fragments of human C3 bind myeloma IgG1 and IgG3 proteins

Eight human myeloma proteins, two of each IgG subclass, were studied for binding to solid-phase C3c and C3d by the ELISA technique. Myeloma IgG₁κ, IgG₁λ, IgG₃κ and IgG₃λ proteins bound to C3c and C3d, while two IgG₂κ, and two IgG₄κ proteins failed to show significant binding affinity. The results suggest that like C1q, the stable binding sites of C3, located on the C3c and C3d parts of the molecule, have affinity for IgG subclasses 1 and 3.     

Probiotics in infancy induce protective immune profiles that are characteristic for chronic low-grade inflammation

Background Probiotics are widely studied both in the treatment and prevention of allergic diseases, but their mode of action is poorly known. Objective Our aim was to examine the effect of probiotic bacteria on in vivo cytokine, antibody, and inflammatory responses in allergy‐prone infants. Methods In a randomized double‐blind study, probiotic bacteria or placebo were given for 1 month before delivery to mothers and for 6 months to infants with a family history of allergy. Plasma samples were analysed for C‐reactive protein (CRP), total IgA and IgE, food‐specific IgA, IgG, and IgE, IL‐2, IL‐4, IL‐6, IL‐10, TNF‐α, and IFN‐γ. We analysed the associations of immunological and inflammatory parameters at age 6 months with probiotic treatment and allergic phenotype at 2 years. Results Infants receiving probiotic bacteria had higher plasma levels of CRP (P=0.008), total IgA (P=0.016), total IgE (P=0.047), and IL‐10 (P=0.002) than infants in the placebo group. Increased plasma CRP level at age 6 months was associated with a decreased risk of eczema [odds ratio (OR) 0.41 [95% confidence interval (CI) 0.17–0.99], P=0.046], and with a decreased risk of allergic disease [OR 0.38 (95% CI 0.16–0.87), P=0.023] at age 2 years, when adjusted with probiotic use. Conclusion The association of CRP with a decreased risk of eczema at 2 years of age in allergy‐prone children supports the view that chronic, low‐grade inflammation protects from eczema. Probiotic‐induced low‐grade inflammation was characterized by elevation of IgE, IgA, and IL‐10, the changes typically observed in helminth infection‐associated induction of regulatory mechanisms. The findings emphasize the role of chronic microbial exposure as an immune modulator protecting from allergy.     

Viewing oneself as a capable person – experiences of professionals working with older Finnish immigrants

The proportion of older immigrants in the population is expected to increase in Sweden. Research indicates that older immigrants face the double burden of frailty, caused by a weaker health status, and the immigration process. Health promotion interventions can be used to prevent frailty and support healthy ageing in this population. Healthcare professionals are a crucial part of health promotion and the present study aimed to explore healthcare professionals’ experiences of health in context of daily life among older immigrants to and provide a basis for the development of a health promotion intervention targeted at older immigrants. Four focus group discussions were conducted with professionals who worked with home‐dwelling older people from Finland, currently living in Sweden. Participants represented a variety of healthcare professions. Data were analysed using qualitative content analysis. The healthcare professionals perceived that health in daily life was (i) connected to the view of oneself as a capable person and (ii) participants strove to maintain their own origin. The findings highlighted that when planning for health promotion interventions for older immigrants, the point of departure should be to recognise the person as a person and the background of immigration is not the first issue to address. Therefore, a person‐centred health promotion intervention is recommended to open a dialogue between healthcare professionals and older immigrants, so that a common view of the intervention can be reached.     

Health-related quality of life of multiple organ dysfunction patients one year after intensive care

OBJECTIVE: To assess the quality of life (QOL) of intensive care survivors 1 year after discharge with special emphasis on multiple organ dysfunction (MOD). DESIGN: Prospective, observational study. SETTING: A ten-bed medical-surgical intensive care unit in a tertiary care hospital. PATIENTS: Among the 591 consecutive patients admitted in the year 1995, 307 of 378 patients who survived 1 year were studied. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A generic scale assessing health-related QOL, the RAND 36-item Health Survey (RAND 36) was sent by mail 12 months after discharge. Data concerning age, severity of illness, organ dysfunctions and diagnoses were recorded. Of 307 patients, 98 (31.9 %) were able to work. The QOL measured by the RAND 36 showed clinically relevant impairment in emotional and physical role limitations compared with an age- and sex-matched general population. MOD (n = 131, 42.7 %) had a statistically significant negative effect on all QOL domains, except bodily pain and mental health, with the only clinically relevant impairment being in vitality and emotional role limitations compared with non-MOD patients. Of the 131 MOD patients, 36 (27.4 %) were able to work, 26 (19.8%) had severe limitations in their daily activities and 5 (3.8 %) were unable to live at home 1 year after discharge. CONCLUSIONS: One year after intensive care the survivors had a lower QOL than an age-matched general population with clinically relevant further impairment of MOD patients in vitality and emotional role limitations.     

Eleven-year trends of stroke in Turku,Finland

The Turku Stroke Register included stroke events at all ages during the years 1982-1992. The incidence of stroke declined in all age groups, even in the oldest one. An even steeper decline was observed in mortality from stroke. Ischemic strokes contributed most to the observed decline, while subarachnoid and intracerebral hemorrhage showed mainly flat trends. Flat trends were also observed for recurrent strokes. The absolute number of strokes remained stable through the study years, but the population above 75 years of age doubled. More than half of the strokes occurred in people aged 75 years or older, and three fourths of them occurred in women. The incidence and mortality rate of ischemic stroke declined steeply in all age groups. Due to an increase in elderly people in the background population, the total number of strokes remained stable. Thus, in spite of the observed declining trends in incidence, the need for stroke care has not diminished.     

Markers of inflammation in the feces of infants with cow's milk allergy

Growing evidence exists that exposure to cow's milk elicits inflammation in the gut of infants with cow's milk allergy, irrespective of symptoms. To demonstrate inflammation and increased protein leakage from the gut during a cow's milk elimination‐challenge test in fecal samples of infants presenting with different symptoms suggestive of cow's milk allergy, we measured the concentrations of α₁‐antitrypsin (AT), eosinophil cationic protein (ECP), immunoglobulin (Ig) A, and cow's milk‐specific IgA antibodies, in fecal samples of 208 infants with a mean age of 7 months. Prechallenge samples were collected after a mean 3‐week elimination period, and post‐challenge samples were obtained 4 days after starting the challenge. Fecal levels of prechallenge total IgA (p = 0.02) and post‐challenge AT (p = 0.001) were higher in infants with a positive challenge. Of these infants, pre‐ and post‐challenge levels of ECP were higher in those reacting after 24 h than in those reacting within 1 h (p = 0.006 and p = 0.045). Prechallenge levels of ECP were higher in those showing intestinal symptoms (p = 0.008), and both pre‐ and post‐challenge levels of total IgA were higher in those with an IgE‐mediated reaction to cow's milk (p = 0.04 and p = 0.008). Regardless of the challenge result, total IgA increased during the challenge (p < 0.001 for both challenge‐positive and ‐negative infants) and was higher in those breast‐fed until the challenge than in those fed formula only (p < 0.01). Hence, in infants reacting to the cow's milk challenge, higher prechallenge levels of fecal IgA indicate increased antigenic stimuli in the gut, and higher post‐challenge levels of AT reflect increased protein loss as a result of intestinal inflammation. In infants with slowly evolving gastrointestinal symptoms, increased fecal ECP may help in distinguishing patients from those who tolerate cow's milk. Individual serial follow‐up of fecal IgA and ECP can be used to estimate the degree of inflammation in the gut and an appropriate time for a challenge test, but are not diagnostic tools for cow's milk allergy.