Inflammation and subjective health : the role of sickness behaviour

Sickness behaviour refers to a set of coordinated behavioural and psychological changes in response to inflammation aimed to redirect available energy to the immune system to promote recovery. Sickness behaviour symptoms closely resemble important determinants of poor self-rated health, which in turn has been coupled to increased levels of inflammatory cytokines. However, it is not known if this association between inflammatory cytokines and self-rated health is mediated by sickness behaviour. Furthermore, it has not yet been established if other systemic and local inflammatory markers affect self-rated health, sickness behaviour and other patient reported outcome measures (PROMs). This thesis main aim was to investigate sickness behaviour as a determinant of self-rated health and as a possible mediator in an association between inflammatory markers and subjective health perception in primary care patients and in patients with asthma. In paper I, a questionnaire to measure sickness behaviour, SicknessQ, was developed and validated in two steps. First, sickness behaviour was experimentally induced by injecting endotoxin in healthy volunteers. The participants completed 37 items describing a broad range of sickness symptoms, items that responded to acute inflammatory provocation were selected and psychometric properties were tested in 172 primary care patients. The results demonstrated adequate psychometric properties for the resulting 10-item SicknessQ-scale and gave support for using SicknessQ as a brief instrument to assess human sickness behaviour. In paper II, the relationship between inflammatory markers, health anxiety, sickness behaviour and self-rated health was investigated in 311 primary care patients, 172 of which were also part of the study population in paper I. Furthermore, mediation analysis was conducted to exploratory investigate if putative relationships between inflammatory markers and self-rated health were statistically mediated by sickness behaviour. The results showed that poor self-rated health was associated with increased sickness behaviour and higher health anxiety. In addition, elevated levels of IL-6 were associated with poor self-rated health in men, although this association was not mediated by sickness behaviour. In paper III and IV, the longitudinal associations between self-rated health, sickness behaviour, asthma-related quality of life, inflammatory markers (paper III: FENO, ECP, EDN, IgE, paper IV: IL-5, IL-6) and lung function were investigated with repeated measurements in 181 patients with allergic asthma during 12-months. Poor self-rated health was associated with increased sickness behaviour, poorer asthma-related quality of life and high levels of seasonal IgE and food IgE but not total IgE or FENO, ECP or EDN. In men, a u-shaped relationship was found where both low and high levels of IL-6 were associated with increased sickness behaviour. Analysed over time, a worsening in sickness behaviour was associated with a worsening of self-rated health. Also, an improvement of asthma-related quality of life was associated with an improvement in self-rated health. In men, but not women, increased lung function measured as FEV1 was associated with an increase in IL-6, better self-rated health and increased asthma-related quality of life over the year. In this thesis, new knowledge is gathered to understand the underpinnings and interrelations between self-rated health, sickness behaviour and inflammation. More sickness behaviour emerged as a more consistent determinant of poor self-rated health compared to inflammatory markers, for which mixed results were found. The results of the thesis highlight the role of sickness behaviour in subjective health perception

Knowledge co-production in the Helge å catchment: a comparative analysis

Addressing sustainability challenges in landscape management requires processes for co-producing usable knowledge together with those who will use that knowledge. Participatory futures methods are powerful tools for attaining such knowledge. The applications of such methods are diverse and understanding the intricacies of the knowledge co-production process is important to further develop these research practices. To improve participatory futures methods and contribute to systematic and critical reflections on methodology, we present a comparative analysis of four research projects that applied participatory futures methods in the same study area. Conducted between 2011 and 2020, these projects aimed to co-produce knowledge about the future provision of ecosystem services in the Helge å catchment area in southern Sweden. For structuring the post-hoc, self-reflexive analysis, we developed a framework dividing the knowledge co-production process into three dimensions: settings, synthesis and diffusion. We based the analysis on documentation from the projects, a two-step questionnaire to each research team, a workshop with co-authors and interviews with key participants. The comparison highlights steps in project decision-making, explicit and implicit assumptions in our respective approaches and how these assumptions informed process design in the projects. Our detailed description of the four knowledge co-production processes points to the importance of flexibility in research design, but also the necessity for researchers and other participants to adapt as the process unfolds

A free but afraid press : a comparative study about limitations, challenges and possibilities for journalists operating in Dominica and Saint Lucia

The purpose of this research is to study how journalists in two Caribbean countries, Dominica and Saint Lucia, see their profession in a developing country where freedom of the press is high but where restrictions also occur. Through semi-structured in-depth interviews we will ask thirteen local journalists in the aforementioned countries what they think about journalistic values and ask for their thoughts on the journalists´ role and responsibility in society. We will also ask them about what limitations there might be to accomplish these ideals. Since every country differs from another, our study will lean on normative theories, and the study will be based on Hallin and Mancini's work Comparing media systems (2004) and their three models of media. According to the respondents in Saint Lucia and Dominica, the main role for the journalists is to report accurate, balanced and fair stories to the audience so that they can make informed decisions in their everyday life. However, the respondents in both countries face challenges in fulfilling these ideals where in Dominica the main challenge is access to information that prevents the press to work on a free basis. In Saint Lucia the respondents state that main obstacles are the “red tape”, i.e., the problematic bureaucratic procedure, that journalists have to deal with when trying to get information, and also threats such as lawsuits and pulled advertisement - something that prevents them from producing free and independent journalism. Detta är en Minor Field Study finansierad uppsats. </p

Associations between self-rated health, sickness behaviour and inflammatory markers in primary care patients with allergic asthma : a longitudinal study

Allergic asthma is a chronic inflammatory disorder associated with elevated levels of immunoglobulin E (IgE), serum eosinophilic cationic protein (S-ECP), plasma eosinophil-derived neurotoxin (P-EDN) and fraction of exhaled nitric oxide (FENO). Poor self-rated health and sickness behaviour has repeatedly been associated with inflammatory markers, but the nature of this relationship in chronic inflammatory disease is not known. Likewise, such findings largely rely on cross-sectional investigations. Self-rated health (How would you rate your general state of health?), sickness behaviour (mean rating of satisfaction with energy, sleep, fitness, appetite and memory), IgE, S-ECP, P-EDN, and FENO were assessed in 181 non-smoking primary care patients with asthma in a 1-year longitudinal study. Associations between repeated measurements were calculated using mixed regression models and Spearman’s correlations for change scores. Poor self-rated health was associated with high levels of seasonal IgE (p = 0.05) and food IgE (p = 0.04), but not total IgE or inflammatory markers. An increase over 1 year in perennial IgE was associated with a worsening of self-rated health (ρ = 0.16, p = 0.04). Poor self-rated health was associated with more pronounced sickness behaviour (p &lt; 0.001), and a worsening in sickness behaviour was associated with a worsening of self-rated health over time (ρ = 0.21, p = 0.007). The study corroborates the importance of sickness behaviour as a determinant of self-rated health by showing that these factors co-vary over a 1-year period in a group of patients with allergic asthma. The importance of specific IgE for perceived health in primary care patients with mild to moderate asthma needs further investigation

"NOYO - CREATING YOUR EXPERIENCE" - A case study on the creation of affective brand script and visual product identity

Visual recognition and emotional contents of product design are increasingly relevant topics with respect to brand management. Within the brand creation process, various symbolic qualities and emotional aspects can be developed around the functional product to create a strong and affective story, or script, for the brand. When creating such brand script, it is particularly important to ensure that different communication media are consistently utilised. In specific, the semantic contents of product design need to be aligned with the brand\u27s core values, so that the design features and characteristics communicate the true essence of the brand. This case paper explores the key aspects of creating an affective and believable story for a brand and expressing it through design. This is illustrated through a student project that was organised in the Chalmers University of Technology in the Autumn of 2005. The paper aims to show how the processes of market analysis, brand creation, and semantic reference building in design could be structured. The Noyo case highlights the importance of holistic approach towards creating affective brands and products. In addition to an excellent product, technically, cognitively and emotionally, appealing story is needed around it and the brand it represents. The key challenge then concerns the transformation of this essence into the visual and other product attributes and, finally, into an emotional presentation of the concept

"NOYO - CREATING YOUR EXPERIENCE" - A case study on the creation of affective brand script and visual product identity

Visual recognition and emotional contents of product design are increasingly relevant topics with respect to brand management. Within the brand creation process, various symbolic qualities and emotional aspects can be developed around the functional product to create a strong and affective story, or script, for the brand. When creating such brand script, it is particularly important to ensure that different communication media are consistently utilised. In specific, the semantic contents of product design need to be aligned with the brand\u27s core values, so that the design features and characteristics communicate the true essence of the brand. This case paper explores the key aspects of creating an affective and believable story for a brand and expressing it through design. This is illustrated through a student project that was organised in the Chalmers University of Technology in the Autumn of 2005. The paper aims to show how the processes of market analysis, brand creation, and semantic reference building in design could be structured. The Noyo case highlights the importance of holistic approach towards creating affective brands and products. In addition to an excellent product, technically, cognitively and emotionally, appealing story is needed around it and the brand it represents. The key challenge then concerns the transformation of this essence into the visual and other product attributes and, finally, into an emotional presentation of the concept

Correction: Longitudinal co-variations between inflammatory cytokines, lung function and patient reported outcomes in patients with asthma.

[This corrects the article DOI: 10.1371/journal.pone.0185019.]

Longitudinal co-variations between inflammatory cytokines, lung function and patient reported outcomes in patients with asthma

Background Asthma is a chronic inflammatory respiratory disorder associated with reduced lung function and poor quality of life. The condition is also associated with poor self-rated health, a major predictor of objective health trajectories. Of biological correlates to self-rated health, evidence suggests a role for inflammatory cytokines and related sickness behaviours. However, this is mainly based on cross-sectional data, and the relation has not been investigated in patients with chronic inflammatory conditions. Objective To investigate inflammatory cytokines, lung function, sickness behaviour and asthma-related quality of life as determinants of self-rated health in patients with asthma, and to investigate if these variables co-vary over time. Methods Plasma cytokines (IL-5, IL-6), lung function (FEV1), sickness behaviour, asthma-related quality of life and self-rated health were assessed in 181 patients with allergic asthma aged 18-64 years in a one-year longitudinal study. Mixed effect regression models and Spearman's correlation were performed to analyse the associations between repeated measurements. Results More sickness behaviour and poorer asthma-related quality of life were associated with poorer self-rated health (p's&lt;0.001). In men, both low and high levels of interleukin (IL)-6 and poorer lung function were related with poorer self-rated health (p's&lt;0.05). Over the year, improved asthma-related quality of life was associated with better self-rated health (Spearman's rho = -0.34 women,-0.36 men, p's&lt;0.01). Further, if sickness behaviour decreased, self-rated health improved, but only in women (Rho = -0.21, p&lt;0.05). Increased FEV1 in men was associated with an increase in IL-6 (Rho = 0.24, p&lt;0.05) as well as improved self-rated health (Rho = -0.21, p&lt;0.05) and asthma-related quality of life (Rho = 0.29, p&lt;0.01) over the year. Conclusion The study highlights the importance of subjectively perceived sickness behaviour and asthma-related quality of life together with lung function as determinants of self-rated health in asthmatic patients. The importance of inflammatory activation for patient reported outcomes in chronic inflammatory conditions need further investigation

Cross-sectional associations between inflammation, sickness behaviour, health anxiety and self-rated health in a Swedish primary care population

This study investigated associations between inflammatory markers, sickness behaviour, health anxiety and self-rated health in 311 consecutive primary care patients. Poor self-rated health was associated with high sickness behaviour ( ρ  = 0.28, P  < 0.001; ρ  = 0.42, P  = 0.003) and high health anxiety ( ρ  = 0.31, P  < 0.001; ρ  = –0.32, P  = 0.003). High levels of interleukin 6 were associated with poor self-rated health in men ( ρ  = 0.26, P  = 0.009). Low levels of interleukin-6 were associated with poor self-rated health in women ( ρ  = –0.15, P  = 0.04), but this association was non-significant when adjusted for health anxiety ( ρ  = –0.08, P  = 0.31). These results are consistent with the theory that interoceptive processes draw on both inflammatory mediators and the state of sickness behaviour in inferring health state