Effects after inhalation of (1-->3)-beta-D-glucan and relation to mould exposure in the home.

BACKGROUND: Damp conditions indoors favour the growth of microorganisms, and these contain several agents that may cause inflammation when inhaled. Moulds contain a polyglucose in their cell wall, defined as (1-->3)-beta-D-glucan, exhibiting effects on inflammatory cells. AIM: The aim of the present study was to evaluate whether an inhalation challenge to purified (1-->3)-beta-D-glucan (grifolan) in humans could induce effects on inflammatory markers in blood, and to evaluate whether the reactions were related to the home exposure to (1-->3)-beta-D-glucan. METHODS: Seventeen subjects in homes with high levels of airborne (1-->3)-beta-D-glucan (G-high) and 18 subjects in homes with low levels of (1-->3)-beta-D-glucan (G-low) underwent two randomised, double-blind inhalation challenges, one to (1-->3)-beta-D-glucan suspended in saline and one to saline alone. A blood sample was taken before and after the challenges, and differential cell count, granulocyte enzymes in serum and the secretion of cytokines from peripheral blood mononuclear cells (PBMC) were measured. RESULTS: Inhalation challenge with (1-->3)-beta-D-glucan induced a decrease in the secretion of tumour necrosis factor alpha from endotoxin-stimulated PBMC in the G-high group as well as in the G-low group. In the G-high group, the inhalation of (1-->3)-beta-D-glucan induced an increase in blood lymphocytes that was significantly different from the saline-induced effect. CONCLUSIONS: The results suggest that an inhalation challenge to (1-->3)-beta-D-glucan has an effect on inflammatory cells and this effect may be related to a chronic exposure to moulds at home

Primary healthcare in transition – a qualitative study of how managers perceived a system change

BACKGROUND: Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. METHODS: In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. RESULTS: The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. CONCLUSIONS: This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager’s perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Air quality and worker health effects in materials recovery facilities (MRFs) in England and Wales.

There are varying types of Materials Recycling Facilities (MRFs, also known as Materials Recovery Facilities, or Materials Recycling Factories) in operation in the UK and throughout Europe. A full outline of the various types of MRF operations is given by the Institute of Wastes Management (IWM 2000). This review concentrates on MRFs used to sort and process sourcesegregated household and commercial waste, the most common type. A MRF that deals with household and commercial waste is defined as a central operation where source-segregated, dry, recyclable materials are sorted, mechanically or manually, to market specifications for processing into secondary materials

Organic dusts and airways inflammation. With reference to the specific agents endotoxin and (1-3)-ß-D-glucan

Objective: Organic dusts may contain different amounts of endotoxin, an inflammatory agent, and glucans for which the effects on humans are largely unknown. In this thesis, endotoxin and (1(3)-ß-D-glucan were used as markers of biomass exposure in three different organic dust environments, i.e. wood and recycled paper handling, household waste handling and homes. In addition, inflammatory responses after acute exposures to lipopolysaccharide, LPS (pure endotoxin) and grifolan (a pure (1(3)-ß-D-glucan) were evaluated among healthy subjects.Methods: Participants in the field studies were 83 workers from a paper industry and 44 controls, 129 tenants from 75 houses in a rowhouse area, some of which had previous problems related to dampness and water leakage, and 25 household waste collectors and 24 controls. The field studies measured levels of airborne endotoxin and (1(3)-ß-D-glucan. To characterize the inflammatory response after inhalation of LPS and (1(3)-ß-D-glucan, 21 healthy subjects inhaled 40 (g LPS and 12 subjects inhaled 125 ng grifolan and were examined before and 24 hours and 72 hours (grifolan) after exposures. The effects of the exposures were evaluated using a questionnaire, spirometry measurements and levels of eosinophilic cationic protein (ECP) and myeloperoxidase (MPO) in serum. Atopy was determined using the Phadiatop test. Airway responsiveness (methacholine test) was determined in the field studies. Induced sputum was analyzed in the household waste collector study and among subjects challenged with LPS and grifolan and differential cell counts, ECP, MPO and cytokines (grifolan) were determined in blood and sputum. Results: The workers in the paper industry were exposed to high levels of airborne endotoxin and (1(3)-ß-D-glucan. Household waste collectors and tenants in the rowhouse area were exposed to moderate levels of (1(3)-ß-D-glucan and to low levels of airborne endotoxin. An increased prevalence of respiratory and general symptoms was observed among paper industry workers, and after inhalation of LPS. Airway responsiveness was increased among the paper industry workers as compared with controls. A decrease in baseline FEV1 related to the number of years lived in the houses with higher (1(3)-ß-D-glucan levels was found among tenants younger than 65 years. In the paper industry study, differences were found between exposed and unexposed in levels of ECP and MPO in serum and in the household waste collector study in the numbers of mononuclear cells in blood. Increased amounts of ECP and MPO in induced sputum and increased neutrophil numbers in blood and sputum were found after inhalation of LPS. The lymphocyte numbers in blood were decreased 72 hours after the challenge with (1(3)-ß-D-glucan.Conclusions: Among paper industry workers, several effects were found in terms of respiratory and general symptoms and inflammatory markers. It is not possible to conclude whether endotoxin and/or (1(3)-ß-D-glucan caused these effects. Inhalation of LPS caused an acute airways inflammation, as demonstrated by higher amounts of inflammatory markers in sputum and an increased prevalence of respiratory symptoms. Taken together, the results suggest the presence of an airways inflammation after exposure to endotoxin and to dusts containing endotoxin. The results also suggest that (1(3)-ß-D-glucan exposure may be associated with effects, but further field and challenge studies are needed

Inhalation of (1→3)-β-D-glucan causes airway eosinophilia

Background: Moulds are present in a variety of environments and aerosols of fungal spores are generated when mouldy materials are handled. Molds contain (1→3)-β-D-glucan, a polyglucose which is present in the cell wall of fungi, certain bacteria and plants

Effects after inhalation of (1→ 3)-β-D-glucan in healthy humans

Background and aim: This study was performed to assess the effects of an exposure to a pure (1→3)-β-D-glucan, a cell wall component of fungi, plants and certain bacteria