Echinococcus multilocularis in red foxes in North Belgium: Prevalence and trends in distribution

A cross-sectional systematic sampling was carried out during three consecutive winters from 2012 to 2015, to update the knowledge on the fox tapeworm (Echinococcus multilocularis) distribution in the red fox (Vulpes vulpes) in Flanders. Earlier studies reported the low endemicity status of this tapeworm in the northern region of Belgium, in contrast to the south of the country and neighbouring countries. Using a modified Segmental Sedimentation and Counting Technique, followed by PCR-RFLP and sequencing, 923 foxes' intestines were examined for the presence of E. multilocularis. Based on microscopic examination, 38 out of 923 foxes were suspected to be infected with either E. multilocularis or Amoebotaenia spp., of which 19 were molecularly confirmed to be E. multilocularis, 18 were found positive for Amoebotaenia spp. and one was negative. The overall prevalence for E. multilocularis of 2.1% confirms the low endemicity of the fox tapeworm in Flanders. However, in one area in the most eastern part of Flanders (Voeren), neighbouring the Netherlands and Wallonia, a prevalence of 57% (12/21) was observed. Continuous monitoring of the fox tapeworm remains needed to assess spatio-temporal trends in distribution and to assess the risk of this zoonotic infection in Europe. The challenging differential diagnosis of E. multilocularis and Amoebotaenia spp. based on microscopic examination calls for attention.

Towards a standardised surveillance for Trichinella in the European Union

Each year, more than 167 million pigs in the European Union (EU) are tested for Trichinella spp. under the current meat hygiene regulations. This imposes large economic costs on countries, yet the vast majority of these pigs test negative and the public health risk in many countries is therefore considered very low. This work reviewed the current Trichinella status across the EU as well as the national level of monitoring and reporting. It also reviewed which animal species were affected by Trichinella and in which species it should be surveyed. This information was used to design a cost-effective surveillance programme that enables a standardised monitoring approach within the EU. The proposed surveillance programme relies on identifying sub-populations of animals with a distinct risk. Low-risk pigs are finisher pigs that originate from so-called controlled housing. All other pigs are considered high-risk pigs. Controlled housing is identified by the application of a specific list of management and husbandry practices. We suggest that member states (MS) be categorised into three classes based on the confidence that Trichinella can be considered absent, in the specified sub-population of pigs above a specified design prevalence which we set to 1 per million pigs. A simple and transparent method is proposed to estimate this confidence, based on the sensitivity of the surveillance system, taking into account the sensitivity of testing and the design prevalence. The probability of detecting a positive case, if present, must be high (>95 or >99%) to ensure that there is a low or negligible risk of transmission to humans through the food chain. In MS where the probability of a positive pig is demonstrated to be negligible, testing of fattening pigs from a sub-population consisting of pigs from controlled housing can be considered unnecessary. Furthermore, reduced testing of finishers from the sub-population consisting of pigs from non-controlled housing might even be considered, if conducted in conjunction with a proportionate sampling scheme and a risk-based wildlife surveillance programme where applicable. The proposed surveillance programme specifies the required number of samples to be taken and found negative, in a MS. A MS with no data or positive findings will initially be allocated to class 1, in which all pigs should be tested. When a MS is able to demonstrate a 95% or 99% confidence that Trichinella is absent, the MS will be allocated to class 2 or 3, in which the testing requirement is lower than in class 1.

[Frequency of oral hygiene nursing in cancer patients in Belgian hospitals. Frequency of nursing interventions and indicators]

This article describes the frequency of mouth care for cancer patients in Belgian hospitals. It also analyses the indicators used for this specific type of compensatory nursing care. The study was designed as a secondary data analysis of the 1990 Belgian Nursing Minimum Data set. The randomised sample included 35,347 oncology patients. Frequency of mouth care was 10.3%. The most important indicators were ventilation (70.58%), nasogastric tube (55.01%), endotracheal tube (43.17%), isolation of the patient (40.57%), malignant neoplasmas of lip, cavity and pharynx (40.21%), age younger than 8 years (37.06%) and disorientation of the patient (31.49%). Frequency of mouth care increased with a higher qualification of staff and higher staffing ratios.

Improved detection of circulating antigen in cattle infected with Taenia saginata metacestodes

In order to improve the sensitivity and the specificity of an existing IgM monoclonal antibody-based ELISA (Brandt et al., 1992) for the detection of circulating antigen in the sera of cattle infected with T. saginata metacestodes, a modified sandwich ELISA was developed. Monoclonal antibodies (MAbs) of the IgG isotype were produced against the excretory-secretory (ES)-products of T. saginata metacestodes. Since it was shown that the affinity of these IgG MAbs for ES antigen was higher than that of the IgM MAbs, the latter were replaced by two IgG1 MAbs (158C11 and 60H8). Furthermore, heat treatment of the sera significantly increased the OD-values of ES-spiked serum samples as compared to nontreated samples. It also decreased the number of false positive reactions. When the original IgM MAb-based ELISA was compared with the IgG MAb-based ELISA using heat treated sera from animals harbouring more than 50 living metacestodes of T. saginata, the sensitivity increased from 56% with the former to 92% with the latter assay. Only a small percentage of animals carrying less than 50 cysts were detected both with the ELISA using IgG or IgM MAbs. The specificity of the IgM- and IgG MAb-based ELISAs was 93.4% and 98.7% respectively.

Inventory of regulations and analysis techniques for trace elements in some water supply companies in eastern and western Europe

With the ultimate objective in contributing to the improvement of the quality control of drinking water and to facilitate the checking of its compliance with the respective regulations, an inventory of analytical techniques used in water supply companies in Eastern and Western European countries is presented. The existing regulations for drinking water and bottled mineral water quality with respect to trace elements in these countries are compared to regulations of the World Health Organisation. The data obtained can be useful for further harmonisation of the respective regulations in Europe.

Adrenocorticotropin hormone, beta-endorphin and cortisol responses to oCRF in melancholic patients

Several authors have reported attenuated adrenocorticotropin hormone (ACTH) responses to corticotropin releasing factor (CRF) administration in melancholic patients as compared with healthy controls. In order to explore the integrity of the hypothalamic-pituitary-adrenal (HPA)-axis in melancholics, we examined the following parameters in 98 subjects: the ACTH; beta-endorphin; and cortisol responses to ovine CRF (oCRF) (100 micrograms/i.v.); and the postdexamethasone cortisol values. We found significant lower CRF-induced ACTH responses in melancholic patients as opposed to healthy controls and minor depressives, while major depressives occupied an intermediate position. The psychopathological correlates of the blunted CRF-induced ACTH responses were feelings of worthlessness, self-reproach, or excessive guilt. The CRF-stimulated beta-endorphin and cortisol response did not differ between the study samples. Higher baseline plasma cortisol was associated with attenuated CRF-induced ACTH responses, but these effects were not pertinent to melancholia. There were no relationships between the disordered oCRF test results, and postdexamethasone cortisol values, age, body size, sex and severity of illness. The diagnostic power of the oCRF and the dexamethasone suppression test for melancholia is enhanced when both test results are combined.

Disturbances in dexamethasone suppression test and lower availability of L-tryptophan and tyrosine in early puerperium and in women under contraceptive therapy

This study investigates the function of the hypothalamic-pituitary-adrenal (HPA)-axis and the availability of L-tryptophan and tyrosine to the brain in postpartum women and in women taking long-term oral contraceptives. To this end, we have measured the following parameters in 50 women (i.e. 9 normal controls, 10 women taking oral contraceptives, and 31 postpartum females): plasma cortisol, L-tryptophan, tyrosine and the amino acids (CAA) known to compete with them for transport through the blood-brain barrier. We have determined the effects of 1 mg of dexamethasone on the above-mentioned biological markers in postpartum females. Plasma cortisol and tyrosine were significantly higher and lower, respectively, in puerperium and in women under contraceptive therapy as opposed to normal controls. L-Tryptophan was significantly lower in postpartum females, whilst the L-tryptophan/CAA ratio did not differ across the three study groups. Postpartum females revealed a significant negative relationship between the availability of L-tryptophan to the brain and postpartum mood, as measured by Zung's Depression and Anxiety Scales and State Anxiety Inventory. Dexamethasone had a significant suppressive effect on L-tryptophan/CAA and tyrosine/CAA ratios, with cortisol nonsuppression appearing in 82% of the postpartum females.

MMPI characteristics of the DSM-III-R avoidant personality disorder

The clinical description provided by the MMPI Scale 0 (Social Introversion, Si) reflects an apparent and striking affinity with the DSM-III--R concept of the avoidant personality disorder which was here investigated by comparing the MMPI variables of 22 avoidant with 60 other, nonavoidant personality disordered inpatients. Both of the groups were diagnosed by use of a semistructured interview (SCID-II). The avoidant group obtained for mean MMPI profile a 2-6-7 (D-Pa-Pt) code. Significant differences were found between groups on MMPI Scales 2 (D), 7 (Pt), 9 (Ma), and 0 (Si). ROC analysis of the diagnostic performance showed the importance and utility of the evaluation of Scale 0 (Si) in the psychodiagnostic assessment of the avoidant personality disorder.

L-5-hydroxytryptophan stimulated cortisol escape from dexamethasone suppression in melancholic patients

The dexamethasone suppression test (DST) was carried out in 62 depressed patients. At 0800 the postdexamethasone cortisol values were determined and 125 mg L-5-hydroxytryptophan (L-5-HTP) was administered. The second cortisol sample at 0930 revealed a significant enhancing effect for L-5-HTP on the postdexamethasone cortisol values in melancholic patients, whereas no effects were detected in minor depressives. Our results show that L-5-HTP converts some DST suppressors into nonsuppressors, whereas the escape from dexamethasone in some nonsuppressors is markedly stimulated. The L-5-HTP-stimulated 0930 postdexamethasone cortisol values performed markedly better than the 0800 DST results: at a cut-off value of greater than or equal to 5 micrograms/dl the sensitivity for melancholia increased from 46% to 68%, and the specificity remained unchanged (96%).

Biological heterogeneity of melancholia: results of pattern recognition methods

In this study, we have measured the following biological variables in 78 depressed inpatients: adrenocorticotrophic hormone (ACTH) responses to corticotropin releasing factor (CRH: 100 micrograms intravenously), postdexamethasone cortisol and ACTH values, and circulating concentrations of L-tryptophan (L-TRP). Patients were categorized according to the DMS-III as (1) minor depression, (2) simple major depression, and (3) major depression with melancholia/psychotic features. By means of various pattern recognition methods, we determined whether these diagnostic groups constitute discrete biological classes or form relevant stages (i.e., continuous categories) in a continuum of progressing biological dysfunction. We established that unipolar depression constitutes one biological continuum characterized by a progression of lower CRH-induced ACTH responses, lower L-TRP levels, and higher postdexamethasone cortisol and ACTH values along the diagnostic spectrum. However, the biological differences in these markers between melancholia and minor depression are quantitatively prominent to the extent that they become qualitative. These findings support the biological heterogeneity hypothesis of melancholia. Simple major depression is a heterogeneous class with regard to the biological markers employed.

[The role of friendship on the development and mental health of adolescents.]

Making friends plays a major part in one's adolescent social life. This article profiles peer influence and friendship evaluation during adolescence. A pilot research program conducted on 195 adolescents aged 14 to 18 shows a number of significant correlations between quantitative and qualitative aspects of friendships and various aspects of mental health, the number of friends and of close friends as well as the quality of interactions and the degree of intimacy lead to positive correlations with various signs such as emotional wavelength, control of one's environment and absence of psychopathological symptoms.