Physical activity and sport-specific training patterns in Swedish sporting and working trial dogs-A questionnaire survey

OBJECTIVE

To explore physical activity patterns, including conditioning exercise and sport-specific training, and management routines utilized by handlers of Swedish sporting and working dogs participating in agility, obedience, rally obedience and working trial disciplines.

PROCEDURES

Dog handlers provided information on competition-level dogs through an internet-based cross-sectional and descriptive survey on physical activity, sport-specific training and management. Results are reported overall and stratified by participation in specific disciplines.

RESULTS

We received 1615 replies to the questionnaire. After data cleaning, 1582 dogs (98%) remained for the analysis. Of these, 430 participated in agility, 790 in obedience, 596 in rally obedience, and 847 dogs had competed in a working trial, i.e., messenger, protection, search or tracking. Number of disciplines performed by each dog varied between one and five. Most common was participation in one (n = 767, 48%) or two (n = 541, 34%) disciplines. Out of the dogs competing in one discipline, 38% (n = 294) were considered to be specialized as they actively trained only that discipline for ≥10 months per year. The vast majority of the dogs (n = 1129, 71%) received more than 1 h of daily physical activity, e.g., walks, and only n = 51 (3%) were never exercised off-leash. Preferred self-selected gait was trot (n = 907, 57%) and gallop (n = 499, 32%). A fifth (n = 319, 20%) never played with other dogs. The majority (n = 1328, 84%) received more than 1 h of vigorous physical conditioning exercise per week. Almost three quarters (n = 1119, 71%) participated in physical conditioning exercise. Two thirds (n = 953, 60%) participated in at least 3 h of sport-specific training per week and only a very small portion (n = 35, 2%) trained their specific discipline less than once per week. Median total work load, i.e., all daily physical activity, vigorous physical conditioning exercise and sport-specific training, was 16.5 h per week.

CONCLUSION AND CLINICAL RELEVANCE

We observe physical activity at moderate to high durations and moderate to vigorous intensities among Swedish sporting and working trial dogs. Most dogs received physical conditioning exercise, but not all dogs were warmed up before training and competition. Our study provides veterinary professionals and dog trainers with valuable insights on the physical exposures and management routines of sporting and working trial dogs.

Inter-centre comparison of data on surgery and speech outcomes at 5 years of age based on the Swedish quality registry for patients born with cleft palate with or without cleft lip

BACKGROUND

The objective of the Swedish cleft lip and palate registry (CLP registry) is to promote quality control, research and improvement of treatment, by the comparison of long-term results. The aim was to compare data from the CLP registry among the six treatment centres, regarding data on surgery and speech outcomes at 5 years of age.

METHODS

The participants were 430 children born in Sweden from 2009 to 2014, with cleft palate with or without cleft lip and without known syndromes and/or additional malformations. The number of primary and secondary palatal surgeries up to 5 years of age, timing of the last primary palatal surgery, percentage consonants correct, percentage non-oral speech errors and perceived velopharyngeal competence at 5 years were assessed. Multivariable binary logistic regression adjusted for sex and cleft type was used to compare results between the six centres.

RESULTS

At one centre (centre 4), the palate was closed in one to three stages, and at the remaining centres in one or two stages. At centre 4, more children underwent a higher number of palatal surgeries, and the last primary palatal surgery was performed at a higher age. Children in centre 4 were also less likely to achieve ≥86% correct consonants (OR = 0.169, P = < 0.001), have no non-oral speech errors (OR = 0.347, P = < 0.001), or have competent or marginally incompetent velopharyngeal competence (OR = 0.244, P = < 0.001), compared to the average results of the other centres. No clear association between patient volume and speech outcome was observed.

CONCLUSIONS

The results indicated the risk of a negative speech result if the last primary palatal surgery was performed after 25 months of age. Whether the cleft in the palate was closed in one or two stages did not affect speech outcome. The Swedish CLP registry can be used for open comparisons of treatment results to provide the basis for improvements of treatment methods. If deviating negative results are seen consistently at one centre, this information should be acted upon by further investigation and analysis, making changes to the treatment protocol as needed.

Dog Handler Beliefs regarding Barriers and Facilitators to Canine Health Promotion and Injury Prevention in Swedish Working Dog Trials and Competitions

Dog trials and competitions involve various sport disciplines, e.g., obedience, agility, working dog trials and rally obedience. Dog handlers navigate their dogs through physically and mentally demanding tasks. The purpose of this study was to gain a better understanding of barriers and facilitators to canine health promotion and injury prevention described by dog handlers.

METHODS

Qualitative inductive content analysis was applied to systematically organize and interpret narrative data from 654 respondents' answers to open-ended questions in an anonymous online inquiry.

RESULTS

Two categories, with seven sub-categories, emerged from the analysis: (1) Challenges in applying the regulations in dog trials and competitions, and (2) Implementation of animal welfare and canine well-being approaches. Respondents described the challenges in applying regulations in dog trials and competitions and lack of scientific research as barriers to their intent to prevent injuries in their dogs. Implementation of animal welfare and canine well-being approaches were described as facilitators.

CONCLUSION

The findings imply that the stakeholders continuously need to work on bridging possible gaps between the canine welfare criteria and the scientific and empirical knowledge in canine sports and performance medicine.

Lifestyle factors and comorbidities in gout patients compared to the general population in Western Sweden: results from a questionnaire study

OBJECTIVE

This study aimed to identify lifestyle factors associated with gout in patients with prevalent gout compared to the general population.

METHOD

Adult patients with gout identified in primary and secondary care in Western Sweden between 2015 and 2017 were sent a questionnaire asking about demographics, lifestyle, and comorbidities. Five age- and gender-matched controls were identified in a random sample of 52 348 individuals aged 16-84 years who participated in the National Public Health survey in Sweden, year 2015. Logistic regression models were used to compare cases and controls with regard to lifestyle factors and comorbidities.

RESULTS

Of the 1589 invited gout patients, 868 (55%) responded. After matching for age and gender, 728 were included in the analysis (82.4% male; mean ± sd age 69.3 ± 10.5 years for men and 71.8 ± 9.9 years for women with gout). Male and female gout patients were significantly more likely to be overweight or obese (men 79% vs 66%; women 78.5% vs 65.3%), to have binge-drinking behaviour (men 29.9% vs 11%; women 13.7% vs 2.9%), and to be ex-smokers, compared to controls. Moreover, male gout patients reported lower levels of physical activity, while diabetes and hypertension were more common in both genders with gout than in controls.

CONCLUSION

In this questionnaire study, gout patients reported significantly more obesity and binge-drinking behaviour and less physical activity than controls. This suggests that there are great unmet needs for the management of lifestyle factors, particularly regarding overweight/obesity and binge drinking, in patients with gout.

Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections

Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.^1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.^4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.⁸ However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.

"Waiting in the Wings"-Next-of-Kin's Experiences of Lifestyle Interventions for People with Schizophrenia

People with schizophrenia have an increased risk of experiencing physical ill health and thus risk premature death. It is important to gain knowledge about the next-of-kin's experiences of lifestyle interventions in order to increase the understanding of the development of health promotion. This study aimed to describe the experiences of next-of-kin of lifestyle interventions for people with schizophrenia. Ten next-of-kin to people diagnosed with schizophrenia were interviewed and content analysis was used to analyze the data. Three categories emerged in the analysis: Low prioritization of physical health, Patients' needs for motivational support and Next-of-kin's' limited and distant participation. Mental health nurses need a holistic view of human beings and to include the patients' physical health and the role of the family in their responsibilities. Further studies are needed that focus on the views of the next-of-kin and the staff from the mental health services about the care and support needs for promoting physical health in this patient group.

OP0173 IMMUNOMODULATION CO-THERAPY WITH PEGLOTICASE: DATABASE TRENDS 2014-2019

Background:

Pegloticase is a PEGylated biologic therapy for patients with uncontrolled gout who have not improved on or could not tolerate conventional urate-lowering therapies.1All biologics have the ability to engender anti-drug antibodies (ADAs) and it is known that some patients given pegloticase develop ADAs that cause them to stop treatment prior to recieving a complete course of therapy.2-3In other rheumatic autoimmune diseases, DMARDs such as methotrexate or azathioprine are used as standard of care to prevent the development of ADAs to biologics. These DMARDs often allow patients to remain on biologic therapies longer and recieve the full therapeutic benefits while minimizing adverse events.4While pegloticase has been used traditionally as monotherapy, recent case series have demonstrated the therapeutic benefit of immunomodulator co-administration, allowing more patients to receive a full course of pegloticase therapy.5-6Little has been published on how widespread this practice is and whether it has changed over time.

Objectives:

To examine medical claims database from 2014-2019 for trends in immunomodulating therapies being co-prescribed with pegloticase.

Methods:

An IQVIA claims database (November 2014 to October 2019) representing 1.3 billion claims, covering 30 million patients diagnosed with gout or CKD, was utilized to search for patients who had received pegloticase. Patients who had recieved pegloticase were classified as having been on an immunomodulating co-therapy if they were prescribed methotrexate or azathioprine within 60 days before or after initiation of their first pegloticase infusion.

Results:

We found relatively steady low rates of immunomodulation co-therapy with pegloticase from 2014 through 2018 ranging from 1% in 2016 to 4% in 2018 (Figure 1). In 2019 however, the proportion of pegloticase patients that were co-treated with methotrexate or azathioprine therapy increased to 15%. Most patients were started on immunomodulating therapy 20 days before to 10 days after initiation of pegloticase. Methotrexate was the more frequently used immunomodulaton co-therapy as compared to azathioprine.

Conclusion:

We found evidence of a relatively dramatic increasing initiation of immunomodulation therapy with pegloticase beginning soon after a November 2018 presentation of a case series which demonstrated improved response rates of pegloticase when co-administered with methotrexate. These data indicate that clinicians began to more frequently employ a strategy of DMARD co-treatment with pegloticase in 2019 to improve response rates to this important gout medicine.

References:

[1]Sundy JS, et al.JAMA2011;306:711-20.

[2]Abeles AM.Arthritis Research & Therapy2014, 16:112

[3]Strand V, et al.BioDrugs2017; 31:299–316.

[4]Krieckaert CL, et al.Arthritis Res Ther2010;12:217.

[5]Botson J and Peterson J.Ann Rheum Dis.2019; 78: A1289.

[6]Bessen SY, et al.Semin Arthritis Rheum.2019;49:56-61.

Disclosure of Interests:

Brian LaMoreaux Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Megan Francis-Sedlak Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Karl Svensson Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Robert Holt Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics

Evaluation of QuickFISH and maldi Sepsityper for identification of bacteria in bloodstream infection

BACKGROUND

Early detection of bacteria and their antibiotic susceptibility patterns are critical to guide therapeutic decision-making for optimal care of septic patients. The current gold standard, blood culturing followed by subculture on agar plates for subsequent identification, is too slow leading to excessive use of broad-spectrum antibiotic with harmful consequences for the patient and, in the long run, the public health. The aim of the present study was to assess the performance of two commercial assays, QuickFISH® (OpGen) and Maldi Sepsityper™ (Bruker Daltonics) for early and accurate identification of microorganisms directly from positive blood cultures.

MATERIALS AND METHODS

During two substudies of positive blood cultures, the two commercial assays were assessed against the routine method used at the clinical microbiology laboratory, Unilabs AB, at Skaraborg Hospital, Sweden.

RESULTS

The Maldi Sepsityper™ assay enabled earlier microorganism identification. Using the cut-off for definite species identification according to the reference method (>2.0), sufficiently accurate species identification was achieved, but only among Gram-negative bacteria. The QuickFISH^® assay was time-saving and showed high concordance with the reference method, 94.8% (95% CI 88.4-98.3), when the causative agent was covered by the QuickFISH^® assay.

CONCLUSIONS

The use of the commercial assays may shorten the time to identification of causative agents in bloodstream infections and can be a good complement to the current clinical routine diagnostics. Nevertheless, the performance of the commercial assays is considerably affected by the characteristics of the causative agents.

Temporal overexpression of SIRT1 in skeletal muscle of adult mice does not improve insulin sensitivity or markers of mitochondrial biogenesis

AIMS

Activation of the NAD⁺ dependent protein deacetylase SIRT1 has been proposed as a therapeutic strategy to treat mitochondrial dysfunction and insulin resistance in skeletal muscle. However, lifelong overexpression of SIRT1 in skeletal muscle does not improve parameters of mitochondrial function and insulin sensitivity. In this study, we investigated whether temporal overexpression of SIRT1 in muscle of adult mice would affect skeletal muscle mitochondrial function and insulin sensitivity.

METHODS

To circumvent potential effects of germline SIRT1 overexpression, we utilized an inducible model of SIRT1 overexpression in skeletal muscle of adult mice (i-mOX). Insulin sensitivity was assessed by 2-deoxyglucose uptake, muscle maximal respiratory function by high-resolution respirometry and systemic energy expenditure was assessed by whole body calorimetry.

RESULTS

Although SIRT1 was highly, and specifically, overexpressed in skeletal muscle of i-mOX compared to WT mice, glucose tolerance and skeletal muscle insulin sensitivity were comparable between genotypes. Additionally, markers of mitochondrial biogenesis, muscle maximal respiratory function and whole-body oxygen consumption were also unaffected by SIRT1 overexpression.

CONCLUSION

These results support previous work demonstrating that induction of SIRT1 in skeletal muscle, either at birth or in adulthood, does not impact muscle insulin action or mitochondrial function.

The early clinical course of infliximab treatment in rheumatoid arthritis: results from the REMARK observational study

OBJECTIVES

We aimed to describe patterns of disease activity during infliximab plus methotrexate (MTX) treatment and explore C-reactive protein (CRP) as a potential marker of early response.

METHODS

REMARK was a phase IV, open-label, observational study of infliximab-naïve adults with rheumatoid arthritis (RA) who received infliximab 3 mg/kg plus MTX for 14 weeks. Treatment response was evaluated in 3 subgroups: patients with <1 year disease duration who were TNF-inhibitor (TNFi)-naïve, patients with ≥ 1 year disease duration who were TNFi-naïve, and patients who had previous TNFi failure or intolerance. In post hoc analyses, CRP kinetic profiles were analysed by EULAR response (good, moderate, non-response) in REMARK and in an independent replication with data from the ASPIRE study.

RESULTS

In the efficacy-evaluable population (n=662), median 28-joint disease activity score (DAS28) improved from baseline to Week 14 (5.2 vs. 3.6, p<0.0001). Regardless of disease history subgroup, most patients had good or moderate EULAR responses at Weeks 2 (64.9%), 6 (74.1%), and 14 (73.6%). DAS28 and its components did not differ across patient subgroups. Disease flare occurred in 16.2% of patients. CRP levels declined markedly at Week 2, but patients who were EULAR non-responders at Week 14 showed a CRP rebound at Weeks 6 and 14. This CRP pattern was independently replicated in data from ASPIRE. Adverse events were consistent with the known risk profile of infliximab.

CONCLUSIONS

Infliximab plus MTX treatment in patients with RA rapidly diminished disease activity. A unique pattern of CRP rebound was found in non-responders early in treatment.

Emission factors for gases and particle-bound substances produced by firing lead-free small-caliber ammunition

Lead-free ammunition is becoming increasingly popular because of the environmental and human health issues associated with the use of leaded ammunition. However, there is a lack of data on the emissions produced by firing such ammunition. We report emission factors for toxic gases and particle-bound compounds produced by firing lead-free ammunition in a test chamber. Carbon monoxide, ammonia, and hydrogen cyanide levels within the chamber were analysed by Fourier transform infrared spectroscopy, while total suspended particles and respirable particles were determined gravimetrically. The metal content of the particulate emissions was determined and the associated organic compounds were characterized in detail using a method based on thermal desorption coupled to gas chromatography and mass spectrometry. The particulate matter (∼30 mg/round) consisted primarily of metals such as Cu, Zn, and Fe along with soot arising from incomplete combustion. Nitrogen-containing heterocyclic aromatic compounds such as carbazole, quinolone, and phenazine were responsible for some of the 25 most significant chromatographic peaks, together with PAHs, diphenylamine, and phthalates. Emission factors were determined for PAHs and oxygenated PAHs; the latter were less abundant in the gun smoke particles than in domestic dust and diesel combustion smoke. This may be due to the oxygen-deficient conditions that occur when the gun is fired. By using an electrical low pressure impactor, it was demonstrated that more than 90% of the particles produced immediately after firing the weapon had diameters of less than 30 nm, and so most of the gun smoke particles belonged to the nanoparticle regime.

Desorption of H2, HD, and D2 through temporary negative ion formation

Physically adsorbed H(2), HD, and D(2) desorbs via the low-energy 2Σ(u)+ electron scattering resonance with characteristic electron energy dependent cross sections as we show by desorption and electron energy-loss measurements. Only H(2) and HD desorb, for energetic reasons, via excitation of the j = 0 → 2 rotational mode and its subsequent decay into free translational motion, while all three isotopes desorb by direct transitions to unbound continuum states, with a probability close to unity and an unexpectedly weak mass dependence ~m(-1/2).

Physical exercise ameliorates deficits induced by traumatic brain injury

The extent and depth of traumatic brain injury (TBI) remains a major determining factor together with the type of structural insult and its location, whether mild, moderate or severe, as well as the distribution and magnitude of inflammation and loss of cerebrovascular integrity, and the eventual efficacy of intervention. The influence of exercise intervention in TBI is multiple, ranging from anti-apoptotic effects to the augmentation of neuroplasticity. Physical exercise diminishes cerebral inflammation by elevating factors and agents involved in immunomodulatory function, and buttresses glial cell, cerebrovascular, and blood-brain barrier intactness. It provides unique non-pharmacologic intervention that incorporate different physical activity regimes, whether dynamic or static, endurance or resistance. Physical training regimes ought necessarily to be adapted to the specific demands of diagnosis, type and degree of injury and prognosis for individuals who have suffered TBI.

Asthma Control Questionnaire in children: validation, measurement properties, interpretation

The Asthma Control Questionnaire (ACQ) has been validated in adults to measure the primary goal of management (minimisation of symptoms, activity limitations, short-acting β₂-agonist use and airway narrowing). The present study evaluated the validity, measurement properties and interpretability of the ACQ in children aged 6-16 yrs. 35 children attended clinic on three occasions (0, 1 and 4 weeks) and completed the ACQ, Mini Paediatric Asthma Quality of Life Questionnaire and the Royal College of Physicians' "Three Questions". Parents completed the Paediatric Asthma Caregiver's Quality of Life Questionnaire. Between visits, children completed the Asthma Control Diary and measured peak expiratory flow. At weeks 1 and 4, clinicians and parents completed Global Rating of Change Questionnaires. All patients completed the study. 19 children were stable between two assessments and provided evidence of good test-retest reliability (intraclass correlation coefficient 0.79). The ACQ was responsive to change in asthma control (p = 0.026) and the mean ± sd Minimal Important Difference was 0.52 ± 0.45. Both cross-sectional and longitudinal correlations between the ACQ and the other outcomes were close to predicted and provided evidence that the ACQ measures asthma control in children. The ACQ has strong measurement properties and is valid for use in children aged 6-16 yrs. In children aged 6-10 yrs, it must be administered by a trained interviewer.

Dissociation of physisorbed H2 through low-energy electron scattering resonances

Electron induced dissociation of physisorbed H2, HD, and D2 proceeds, as we observe in electron energy-loss measurements of the resulting atomic species, with a high quantum efficiency via the 2Σg(+) core excited electron scattering resonances. We find that the predominant decay of the temporary H2(-) state to the neutral excited 3Σu(+) parent state, which is intramolecularly antibonding, provides a sufficiently long-lived channel for dissociation to occur with high probability, even in the proximity of a metal surface.

Allele-specific in situ hybridization (ASISH)

An unexpected outcome of the diploid genome is that evolutionary strategies have evolved to express only one of the alleles (1). The rapidly expanding list of genes that are expressed monoallelically fall into three main categories: random inactivation, allelic exclusion, and genomic imprinting. These categories are distinguished by whether the expressed and inactivated alleles are maintained from one cell division to the next (random inactivation occurs with each cell division, compared to stable propagation through subsequent cell divisions as seen for allelic exclusion and genomic imprinting) and whether allele inactivation or expression is determined by parent of origin of inheritance (this differentiates allelic exclusion from genomic imprinting). Genomically imprinted genes are currently more numerous than members of the other categories. This fact is likely to reflect that the persistent (in)activation of one allele in a parent of origin-specific manner has facilitated the detection of monoallelic expression patterns in RNA extracted from homogenized tissue. This crude approach does not take into account, however, different imprinted states within a tissue, or, indeed, random allelic (in)activation. It is not surprising, therefore, that well-known genes, such as Il2 (2), were only recently found to be monoallelically expressed in a random manner (1).

Development and validation of the Capacity of Daily Living during the Morning questionnaire and the Global Chest Symptoms Questionnaire in COPD

This report concerns the development and validation of two patient-reported outcomes questionnaires developed to assess chronic obstructive pulmonary disease (COPD) patients' ability to perform morning activities and to evaluate their morning symptoms. Based on interviews with COPD patients, the Capacity of Daily Living during the Morning (CDLM) questionnaire and the Global Chest Symptoms Questionnaire (GCSQ) were developed, linguistically validated and incorporated into two multicentre, randomised trials involving a total of 1,100 COPD patients; those trials were registered at ClinicalTrials.gov (NCT00496470 and NCT00542880). Data from these trials were used to determine the reliability, validity and responsiveness of the questionnaires and to derive estimates of minimal important differences (MIDs). Both questionnaires displayed good-to-high reliability (Cronbach's alpha 0.75-0.93). Analysis of convergent validity showed that CDLM and GCSQ scores correlated significantly (p<0.001) with symptoms, health-related quality of life (HRQoL) and use of rescue medication. In both trials, CDLM and GCSQ scores discriminated between patients with different levels of HRQoL, as assessed by the St George's Respiratory Questionnaire for COPD patients (SGRQ-C), but not with disease severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. A significant improvement in CDLM and GCSQ scores occurred in response to treatment. Estimations of MID scores, corresponding to an SGRQ-C MID of 4, were 0.20 for the CDLM questionnaire and 0.15 for the GCSQ. Both the CDLM questionnaire and the GCSQ are easy-to-use, reliable, responsive, self-administered questionnaires that report on patients' symptoms and ability to perform morning activities.

Electron-induced desorption of physisorbed H2 via resonance vibrational excitation

We show by electron energy-loss measurements that desorption of physisorbed H(2) and D(2) induced by low-energy electrons takes place with large cross sections, predominantly via resonance excitation of the molecule-surface vibrational mode. The observed H(2), D(2) cross-section ratio supports a picture where rotation-translation conversion of the resonance excited j = 0 --> 2 rotational transition contributes to the desorption of H(2), while this channel is energetically closed for D(2).

Probabilistic modelling of exposure doses and implications for health risk characterization: glycoalkaloids from potatoes

Potatoes are a source of glycoalkaloids (GAs) represented primarily by alpha-solanine and alpha-chaconine (about 95%). Content of GAs in tubers is usually 10-100 mg/kg and maximum levels do not exceed 200 mg/kg. GAs can be hazardous for human health. Poisoning involve gastrointestinal ailments and neurological symptoms. A single intake of >1-3 mg/kg b.w. is considered a critical effect dose (CED). Probabilistic modelling of acute and chronic (usual) exposure to GAs was performed in the Czech Republic, Sweden and The Netherlands. National databases on individual consumption of foods, data on concentration of GAs in tubers (439 Czech and Swedish results) and processing factors were used for modelling. Results concluded that potatoes currently available at the European market may lead to acute intakes >1 mg GAs/kg b.w./day for upper tail of the intake distribution (0.01% of population) in all three countries. 50 mg GAs/kg raw unpeeled tubers ensures that at least 99.99% of the population does not exceed the CED. Estimated chronic (usual) intake in participating countries was 0.25, 0.29 and 0.56 mg/kg b.w./day (97.5% upper confidence limit). It remains unclear if the incidence of GAs poisoning is underreported or if assumptions are the worst case for extremely sensitive persons.