Nahrungsmittelvergiftung mit marinen Toxinen

Die paralytische- und die Kugelfischvergiftung sind schwere und manchmal auch lebensbedrohliche Vergiftungen, welche durch den Verzehr von mit STX oder TTX kontaminierten Muscheln oder Fischen hervorgerufen werden. Lange Zeit ist man davon ausgegangen, dass TTX vom Kugelfisch selbst produziert wird, doch sein Nachweis in bestimmten Kraken, Seesternen und anderen Kreaturen hat darauf hingewiesen, dass TTX durch Bakterien einschließlich Alteromonas, Vibrio und andere bakterielle Gattungen erzeugt wird. Anders als beim Kugelfisch werden PSP-Toxine (STX und GTX) von toxischen Dinoflagellatarten wie Alexandrium tamarensis und Gymnodinium catenatum, die von Muscheln als Nahrung aufgenommen werden, produziert. Die chemische Struktur der beiden Toxine unterscheidet sich dadurch, dass STX aus Tetrahydropurin Derivaten besteht und TTX ein Aminoperhydrochinazolin ist, trotzdem weisen sie ähnliche Symptome auf. PFP und PSP gehören zu den akuten Vergiftungen. Die gesundheitlichen Auswirkungen der episodischen und chronischen Aufnahme der Toxine sind kaum bekannt. Symptome sind ein stechendes, kribbelndes Gefühl an den Lippen, der Zunge und in den Fingerspitzen, gefolgt von einem Taubheitsgefühl in den Extremitäten und im Gesicht. Die Vergiftung verläuft weiter mit Übelkeit, Erbrechen, einem unkoordinierten Gang und mit einer nachfolgenden aufsteigenden Lähmung. Es ist derzeit für beide Vergiftungen kein Gegenmittel verfügbar. Die Symptome beider Vergiftungen entstehen durch die selektive Blockade der Natrium-Kanäle, wodurch der Natrium-Ionen-Einstrom in die Zelle gehemmt wird, was zur Lähmung der betroffenen Muskeln führt. TTX wird seit langem wie STX durch die Maus-Bioassay-Methode bestimmt, diese ist einfach, aber nicht spezifisch für diese Toxine. Spezifischere Methoden, die seit längerem zur Analyse angewendet werden, sind HPLC, GC-MS und HPLC-MS.The paralytic intoxication as well as the pufferfish poisoning are severe and sometimes even life-threatening. The poison gets in contact with the body through the consumption of contaminated mussels or fish, which contain STX or TTX. For a long time it has been acted on the assumption that TTX was produced by the pufferfish itself, but traces of this poison in octopuses, starfish and other creatures give evidence of TTX originating from bacteria, including species of Alteromonas, Vibrio and other bacterial genera. Unlike in pufferfish, PSP toxins (STX and GTX) are produced by toxic dinoflagellate species, like Alexandrium tamarensis, Gymnodium catenatum, which constitute the major food source of mussels. The chemical structure of both toxins varies in STX being a tetrahydropurine derivative and TTX an aminoperhydroquinazoline; despite the conformational differences both cause similar symptoms. PFP and PSP trigger acute symptoms of poisoning. The symptoms are a tingling sensation on the lips, the tongue and the fingertips, followed by a feeling of numbness in the extremities and in the face. The intoxication proceeds with nausea, vomiting, uncoordinated movement and an increasing paralysis. Presently, there is no antidote available. The symptoms of both intoxications result from the blocking of sodium channels, thereby inhibiting the transport of sodium ions across the cell membrane. TTX as well as STX can be determined by the mouse bioassay method, which is simple but not specific for those toxins. More specific methods like HPLC, GC-MS and HPLC-MS can also be used for analysis

“When it goes back to my normal I suppose”: a qualitative study using online focus groups to explore perceptions of ‘control’ amongst people with eczema and parents of children with eczema in the UK

Objective: To inform the development of a core outcome set for eczema by engaging with people with eczema and parents of children with eczema to understand their experiences and understanding of the concept “eczema control”. Design: 37 participants took part in a total of 6 semi-structured online focus groups held in a typed chatroom with 5-7 participants per group. Three groups involved adults with eczema and three groups involved parents of children with eczema. Framework analysis was used for data analysis. Setting: A community-based sample was recruited from across the UK via social media and email. Participants: 19 adults aged 17-61 (15/19 female, 16/19 white) and 18 parents of children with eczema aged 9 months-17 years (9/18 female, 18/19 white). Results: Four main themes were identified. 1) “Commonalities and differences in the experiences of control”: a reduction in symptoms such as itch and sleep loss characterised eczema control, but what level was acceptable differed across participants. 2) “Eczema control goes beyond the skin”: psychological factors, social factors, the constant scratching and the impact on everyday activities are a variety of ways an individual can be impacted. 3) “Stepping up and down of treatment”: participants’ stepped-up treatment in response to loss of control, but several factors complicated this behaviour. Control needed to be maintained after stepped-up treatment ended to be acceptable. 4) “How to measure control”: self-report was generally preferred to allow frequent measurements and to capture unobservable features. Although most thought their eczema needed to be measured frequently, many also felt that this was not always realistic or desirable. Conclusions: Eczema “control” is a complex experience for people with eczema and parents of children with the condition. These experiences could have important implications on how long-term control should be measured in eczema clinical trials and clinical practice

Treatment non-adherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers’ views.

Background: Non-adherence to prescribed treatments is the primary cause of treatment failure in pediatric long-termconditions. Greater understanding of parents and caregivers’ reasons for non-adherence can help to address thisproblem and improve outcomes for children with long-term conditions.Methods: We carried out a systematic review and thematic synthesis of qualitative studies. Medline, Embase,Cinahl and PsycInfo were searched for relevant studies published in English and German between 1996 and 2011.Papers were included if they contained qualitative data, for example from interviews or focus groups, reporting theviews of parents and caregivers of children with a range of long-term conditions on their treatment adherence.Papers were quality assessed and analysed using thematic synthesis.Results: Nineteen papers were included reporting 17 studies with caregivers from 423 households in five countries.Long-term conditions included; asthma, cystic fibrosis, HIV, diabetes and juvenile arthritis. Across all conditions caregiverswere making on-going attempts to balance competing concerns about the treatment (such as perceived effectivenessor fear of side effects) with the condition itself (for instance perceived long-term threat to child). Although the barriersto implementing treatment regimens varied across the different conditions (including complexity and time-consumingnature of treatments, un-palatability and side-effects of medications), it was clear that caregivers worked hard toovercome these day-to-day challenges and to deal with child resistance to treatments. Yet, carers reported that stricttreatment adherence, which is expected by health professionals, could threaten their priorities around preserving familyrelationships and providing a ‘normal life’ for their child and any siblings.Conclusions: Treatment adherence in long-term pediatric conditions is a complex issue which needs to be seen in thecontext of caregivers balancing the everyday needs of the child within everyday family life. Health professionals maybe able to help caregivers respond positively to the challenge of treatment adherence for long-term conditions bysimplifying treatment regimens to minimise impact on family life and being aware of difficulties around child resistanceand supportive of strategies to attempt to overcome this. Caregivers would also welcome help with communicatingwith children about treatment goals

Comparing the quantity and quality of randomized placebo-controlled trials of antibiotics for acute respiratory, urinary, and skin and soft tissue infections:a scoping review

BACKGROUND: The management of acute respiratory infections (ARIs), urinary tract infections (UTIs), and skin and soft tissue infections (SSTIs) should be guided by high quality evidence.AIM: To compare the quantity and quality of randomised placebo-controlled trials of antibiotics for ARIs, UTIs, and SSTIs.DESIGN &amp; SETTING: A scoping review of the literature was performed using comprehensive search strategies.METHOD: PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for published studies from inception until 17 April 2019. Randomised controlled trials (RCTs) that compared participants in primary care or in the community who had uncomplicated acute ARI, UTI, or studies, and were randomised to antibiotic or placebo (or no active treatment), were eligible for inclusion. Two groups of researchers independently screened articles for inclusion, extracted data, and assessed the quality of included studies.RESULTS: A total of 108 eligible studies were identified: 80 on ARI, eight on UTI, and 20 on SSTI. The quality of studies varied with unclear risk of bias (RoB) prevalent in many domains. There was a gradual improvement in the quality of trials investigating ARIs over time, which could not be assessed in SSTI and UTI studies.CONCLUSION: This review highlights a sparsity of trials assessing the effectiveness of antibiotics in people with UTIs and SSTIs, compared to trials targeting ARIs. This gap in the evidence needs to be addressed by conducting further high quality trials on the effects of antibiotics in patients with UTI and SSTI.</p

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study in primary and secondary care

Background: Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg: approximately a third of people experience recurrence. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.Aim: To explore patients’ perceptions of cellulitis and their information needs.Design and Setting: Mixed methods study comprising semi‐structured, face‐to‐face interviews and a cross‐sectional survey, recruiting through primary care, secondary care and advertising.Methods: Adults aged 18 or over with a history of cellulitis were invited to take part in a survey, qualitative interview, or both.Results: Thirty interviews were conducted between August 2016 and July 2017. Qualitative data highlighted: (1) low awareness of cellulitis prior to first episode, 2) uncertainty around the time of diagnosis, 3) concern/surprise at the severity of cellulitis, 4) perceived insufficient information provision. People were surprised they had never heard of cellulitis and that they had not received advice or leaflets giving self‐care information. Some sought information from the internet and found this confusing. Two hundred and forty surveys were completed (response rate 17%). These showed that, while many participants had received information on the treatment of cellulitis (60.0%, n=144), they often reported receiving no information about causes (60.8%, n=146) or prevention of recurrence (73.3%, n=176).Conclusions: There is a need to provide information for people with cellulitis, particularly around (1) the name of their condition, (2) managing acute episodes and (3) reducing risk of recurrences

How parents and children evaluate emollients for childhood eczema: a qualitative study

BACKGROUND: Eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current ‘trial and error’ approach to find suitable emollients can be frustrating for parents, children, and clinicians. AIM: To identify how parents and children experience and evaluate emollients. DESIGN AND SETTING: Qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial). METHOD: Semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity. RESULTS: Forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration. CONCLUSION: There is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them

Parents and carers' experiences of seeking health information and support online for long-term physical childhood conditions: A systematic review and thematic synthesis of qualitative research

© BMJ Publishing Group Limited 2020. Objective To systematically review and synthesise qualitative research exploring parents/carers' experiences of seeking online information and support for long-term physical childhood conditions. Design Systematic review and thematic synthesis of qualitative research. Data sources Medline, CINAHL, Embase, PsycINFO and the International Bibliography of the Social Sciences were searched from inception to September 2019. We used thematic synthesis to analyse findings. Eligibility criteria Primary research papers presenting qualitative data collection and analysis, focusing on parents/carers' experiences of seeking health information and support from online resources for long-term physical childhood health conditions. No language restrictions were placed. Results 23 studies from seven countries met inclusion criteria and were included in the synthesis. Included studies presented data collected through interviews/focus groups with 559 parents/carers; free-text surveys and essays with 26 parents/carers and 2407 messages from online support groups. Parents/carers developed a variety of strategies to obtain information and support online, based on personal preferences, appraisal of trustworthiness, perceived needs and previous experiences online. Many parents sought the benefits of online information and support, which included reassurance and validation from online communities, and feeling they had greater knowledge about their children's conditions. Some concerns and perceived risks were discussed, which often stemmed from prior unsatisfactory experiences of seeking information and support online, consultations with health professionals and seeing distressing stories online. Conclusion Most parents/carers were successful in obtaining information and support online. Many continued to share experiences with other parents/carers online. The need for information was particularly apparent early after diagnosis of the condition, whereas the need for peer support continued. The potential concerns and perceived risks with information and support online were especially apparent among parents/carers of children with life-limiting long-term conditions. Findings may be useful for health professionals to facilitate discussions regarding use of online resources, and researchers designing online health resources for parents/carers. PROSPERO registration number CRD42018096009