The latex allergic psychiatric patient

Latex allergy is an immune system illness affecting an increasing number of individuals. People with latex allergy often experience anxiety and fear about real and potential exposure to products containing natural rubber latex. Nurses working in acute care and general medical-surgical areas are more likely to be aware of this emerging illness than nurses working on a psychiatric unit. The nature of latex allergy and the immune system response are described in this article. People with latex allergy may react when they are exposed to latex allergens or specific foods. This article identifies nursing interventions and describes those appropriate for people with anxiety or fear responses. Patients with latex allergy can be managed when nursing staff understand both the medical and psychiatric aspects of care.     

T-CIA: investigating T cells in aging

Over the past few decades it has become clear that the immune system and especially T cells are instrumental in achieving a long and healthy life. The European Union (EU) previously supported several pan-European research projects coordinated from Tuebingen, Germany, aimed at providing a better understanding of immunosenescence. For 3 years, until the end of 2005, the EU is supporting a project called T cells in aging (T-CIA). The aim of T-CIA is to spy out and combine current efforts in immunology, molecular biology, and gerontology for a better understanding of why the elderly often have dysregulated immune responses and are more susceptible to infections and cancer.     

Influence of physiological androgen levels on wound healing and immune status in men

Aging in men is associated with a progressive decline in the production of several hormones, including androgens. The extent to which an age-dependent decline in androgen levels lead to health problems or can affect quality of life remains under debate. Clinical results on replacement therapy do not yet provide a definitive clue on the benefit/risk balance. A sexual dimorphism of the immune system is well established, and the differences between female and male immune responses under normal, as well as pathological, conditions are generally attributed to the influence of estrogens, progestins, and androgens. The suppressive effects of male sex hormones on immune functions have been observed in a wide variety of disease processes and appear to be testosterone-mediated. Endogenous testosterone inhibits skin wound healing response in males and is associated with an enhanced inflammatory response. Although there are no known gender-related differences in permeability barrier function in adults, estrogens accelerates—whereas testosterone retards—barrier development in fetal skin, and male fetuses demonstrate slower barrier development than female littermates.     

林晓东:潜心研究“耐挫教育”

林晓东是美国哥伦比亚大学教育学院终身教授,哥伦比亚大学创新与耐挫教育研究中心主任,当下主要致力于抗挫能力的研究。她发现,抗挫能力就好像人体的免疫系统,一旦染病就会被激活来应对疾病。她希望孩子能在困难和挫折面前也自行激活一套类似的心理机制来应对。     

Immunity challenge

As people get older, their immune systems falter. The elderly are more susceptible to infections than youngsters are, and hyperactive inflammatory responses appear to contribute to some age-associated illnesses, including Alzheimer's disease and atherosclerosis. Investigating the effect of aging on the immune system was once a scientific stepchild, but card-carrying immunologists are now tackling the problem head-on. Despite the immune system's complexity, researchers have started to make sense of how its components change with age. As the research progresses, scientists hope to bolster elderly people's response to infectious diseases and quiet the inflammation that can make aging a painful experience.     

The role of exercise on the innate immunity of the elderly

The increased life span in human population has shown that some diseases, as infections, cancer and autoimmune phenomena, occur more frequently in the elderly than in the younger. We describe the ageing process involving the innate immune system and the improvement given by moderate physical activity. In addition, we discuss the altered neutrophil granulocytes function, the role of macrophages and natural killer cells, besides the influence of cytokines and secretory IgA. The acquired information help us to explain how these changes could favor the onset of diseases in the elderly and how they may boost their immune function.     

Acquired immunity: immunosenescence and physical activity

Several lines of evidence indicate that infectious diseases, cancer, and autoimmune disorders occur more frequently in elderly people, thus suggesting that altered function of immune organs and cells, such as thymus and T and B lymphocytes are of primary importance in the pathogenesis of these diseases. Furthermore, old subjects are less responsive to vaccine than younger because of immune changes. The most common changes accompanying the adaptive immune system include decrement of T and B cells proliferation, repertoire degeneracy, increase of the memory cell type, decreased numbers of naive cells, and shift from T helper₁ (Th1) to T helper₂ (Th2) response. Regular exercise in the elderly may improve the alterations in acquired immunity which follow the physiological process of aging, allowing a major resistance against external pathogens and a better quality of life.     

When T cells get old

Why is vaccination against infectious diseases less effective in older patients than in younger ones? Why do the elderly suffer from more frequent and severe infectious episodes than the young? The answer to both these questions is immunosenescence--the poorly defined changes that occur in the immune system as a result of the disrupted performance of multiple components of immunity. Presentations from a recent workshop, which are summarized here, examined these questions and provided some insights from the perspective of improving vaccination strategies among the elderly.     

T Cell Immunity and Aging

The effect of age on the immune system is generally detrimental and results in "immunosenescence," a poorly-defined state inadequately reflected in clinical data and for which few reliable "biomarkers of aging" are available. The multinational consortium "T-Cell Immunity in Ageing," T-CIA, was set up to examine these issues specifically as applied to T lymphocytes. This Perspective discusses some of the outcomes of a recent conference that considered progress toward resolving these questions in humans.     

Innate immunity, local inflammation, and degenerative disease

The brain lesions associated with Alzheimer's disease (AD), which are referred to as neurofibrillary tangles and senile plaques, are characterized by the presence of a broad spectrum of inflammatory mediators. Surprisingly, these mediators, which include complement proteins, inflammatory cytokines, prostaglandins, and acute phase reactants such as C-reactive protein and amyloid P, are produced by resident brain cells, including neurons. Although secondary to the fundamental pathology caused by the presence of tangles and plaques, there is strong evidence that inflammation exacerbates the neuronal loss. In particular, AD lesions show evidence of self-attack by the complement system--a part of the immune system that normally functions to rid the body of invading pathogens. However, the lesions are devoid of significant T cell infiltration, a hallmark of an inflammatory immune response, and antibodies. We define this phenomenon as autotoxicity to distinguish it from classical autoimmunity, in which the body raises antibodies to normal endogenous macromolecules. Locally produced inflammatory mediators have also been identified in atherosclerotic plaques, along with evidence of complement self-attack. As was previously shown for heart attacks, epidemiological evidence indicates that extended use of nonsteroidal anti-inflammatory drugs (NSAIDs) results in a reduced risk of AD. NSAIDs inhibit the production of prostaglandin inflammatory mediators, but powerful new therapeutic agents might be developed by targeting more critical inflammatory mechanisms, especially the complement system.     

Job strain in different types of employment affects the immune response

The immune system, in cooperation with neuroendocrine functions, defends from cancer and infections mainly by the activity of blood natural killer (NK) cells. Blood NK activity may be influenced by the type of employment since work is the central part of life; moreover, job stress is a situation affecting both neuroendocrine and immune systems. This study examines anxiety (by STAI 1 and 2), job strain (by the Karasek's JCQ) and blood NK activity (by an in vitro radio-isotopic method) of 134 male workers. These men, over 38 years old with stable employment, were working in factories, in construction yards, in offices, as hospital attendants or as self-employed craftsmen. Workers in factories and in construction yards, with high job strain, showed lower NK activity, while office employees, with low job demand, and craftsmen with low anxiety and elevated decision latitude, showed higher NK activity; the level of NK activity of the hospital attendants was between the other groups. In conclusion, this study confirms that the type of employment, related to job stress, affects blood NK activity. Moreover, blood NK activity may be used in the bio-monitoring of workers at high risk.     

The cost effectiveness of hepatitis immunization for US college students

Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to consider infection risks and disease progression and then compared the cost of vaccination with economic, longevity, and quality of life benefits. Immunization of 100,000 students would prevent 1,403 acute cases of hepatitis A, 929 cases of hepatitis B, and 144 cases of chronic hepatitis B. Hepatitis B vaccination would cost the health system $7,600 per quality-adjusted life year (QALY) gained but would reduce societal costs by 6%. Hepatitis A/B vaccination would cost the health system dollar 8,500 per QALY but would reduce societal costs by 12%. Until childhood and adolescent vaccination can produce immune cohorts of young adults, college-based hepatitis immunization can reduce disease transmission in a cost-effective manner.     

"It's all in your mind": The final common pathway

The relatively new field of Psychoneuroimmuonology (PNI) seeks to reveal links between many systems of the body once thought to work independently of each other. Through a growing body of research, scientists are revealing that what goes on in our mind impacts not only our mental well being but our state of physical health. Presented here is an overview of the stress response and discussion regarding the effects of stress on physiological processes. Of particular interest is the role stress plays on the ability of the immune system to function properly. Both landmark and current research is cited which supports connections between these systems. Finally, the future of PNI is discussed as well as the role health care providers may take to embrace mind/body philosophies.     

Role of physical activity in tumor patients and possible underlying mechanisms

A growing knowledge regarding the influence of exercise on adverse physiologic outcomes associated with cancer and its treatment exists. Aside from its effects on psychological behavior, quality of life, and cancer-related fatigue, physical exercise can target physical and cardio-respiratory fitness, insulin regulation and metabolic syndrome, body weight and composition, and immune function in tumor patients. The increasing number of study results for different cancer types, which prove the positive influences of physical activity in cancer patients, changed the contradictory opinions which existed until the end of the last century. Although an increasing number of studies showing the positive effects of physical activity and more specifically of endurance and resistance training in cancer patients have been published, the underlying mechanisms are mostly unknown. Thus, we summarized the current knowledge of the effects of physical activity and specific training in different tumor entities with specific respect to the possible underlying mechanisms. Especially, the association between physical activity and (1) the improvement of fatigue and the role of free radicals in this process, (2) the counterbalance of tumor-induced cachexia, (3) the improvement of the immune system for supportive tumor treatment, and (4) the possible role of epigenetic modulation against tumor and tumor treatment-dependent adverse physiologic outcomes is focused.     

The Cost Effectiveness of Hepatitis Immunization for US College Students

Abstract

Hepatitis B immunization is recommended for all American children, and hepatitis A immunization is recommended for children who live in areas with elevated disease rates. Because hepatitis A and B occur most commonly in young adults, the authors examined the cost effectiveness of college-based vaccination. They developed epidemiologic models to consider infection risks and disease progression and then compared the cost of vaccination with economic, longevity, and quality of life benefits. Immunization of 100,000 students would prevent 1,403 acute cases of hepatitis A, 929 cases of hepatitis B, and 144 cases of chronic hepatitis B. Hepatitis B vaccination would cost the health system $7,600 per quality-adjusted life year (QALY) gained but would reduce societal costs by 6%. Hepatitis A/B vaccination would cost the health system $8,500 per QALY but would reduce societal costs by 12%. Until childhood and adolescent vaccination can produce immune cohorts of young adults, college-based hepatitis immunization can reduce disease transmission in a cost-effective manner.     

Immune responses to low back pain risk factors

$\underline{Objective}$: Investigate effects of interactions between biomechanical, psychosocial and individual risk factors on the body's immune inflammatory responses. $\underline{Background}$: Current theories for low back pain causation do not fully account for the body's response to tissue loading and tissue trauma. $\underline{Methods}$: Two groups possessing a preference for the sensor or intuitor personality trait performed repetitive lifting combined with high or low mental workload on separate occasions. Spinal loading was assessed using an EMG-assisted subject-specific biomechanical model and immune markers were collected before and after exposure. $\underline{Results}$: Mental workload was associated with a small decrease in AP shear. Both conditions were characterized by a regulated time-dependent immune response making use of markers of inflammation, tissue trauma and muscle damage. Intuitors' creatine kinase levels were increased following low mental workload compared to that observed in Sensors with the opposite trend occurring for high mental workload. $\underline{Conclusions}$: A temporally regulated immune response to lifting combined with mental workload exists. This response is influenced by personality and mental workload.     

Progesterone: the forgotten hormone in men?

‘Classical’ genomic progesterone receptors appear relatively late in phylogenesis, i.e. it is only in birds and mammals that they are detectable. In the different species, they mediate manifold effects regarding the differentiation of target organ functions, mainly in the reproductive system. Surprisingly, we know little about the physiology, endocrinology, and pharmacology of progesterone and progestins in male gender or men respectively, despite the fact that, as to progesterone secretion and serum progesterone levels, there are no great quantitative differences between men and women (at least outside the luteal phase). In a prospective cohort study of 1026 men with and without cardiovascular disease, we were not able to demonstrate any age-dependent change in serum progesterone concentrations. Progesterone influences spermiogenesis, sperm capacitation/acrosome reaction and testosterone biosynthesis in the Leydig cells. Other progesterone effects in men include those on the central nervous system (CNS) (mainly mediated by 5α-reduced progesterone metabolites as so-called neurosteroids), including blocking of gonadotropin secretion, sleep improvement, and effects on tumors in the CNS (meningioma, fibroma), as well as effects on the immune system, cardiovascular system, kidney function, adipose tissue, behavior, and respiratory system. A progestin may stimulate weight gain and appetite in men as well as in women. The detection of progesterone receptor isoforms would have a highly diagnostic value in prostate pathology (benign prostatic hypertrophy and prostate cancer). The modulation of progesterone effects on typical male targets is connected with a great pharmacodynamic variability. The reason for this is that, in men, some important effects of progesterone are mediated non-genomically through different molecular biological modes of action. Therefore, the precise therapeutic manipulation of progesterone actions in the male requires completely new endocrine-pharmacological approaches.     

Immune shaping and the development of Alzheimer's disease vaccines

Given the emotional, social, and financial devastation wrought by Alzheimer's disease (AD), it is imperative that effective therapeutics be devised to ameliorate this presently incurable disorder. Vaccine-based approaches have been developed to target and eliminate amyloid beta (Abeta), a key peptide implicated in AD pathogenesis. Preclinical successes in AD mouse models created excitement and impetus for the clinical application of an Abeta-based vaccine. Eliciting immune responses against a self-peptide (that is, a peptide produced by the organism itself), such as Abeta, carries with it the potential to induce autoimmune and inflammatory conditions in the vaccinated individual, a caveat borne out in multiple patients enrolled as part of a recent clinical trial. These clinical adverse events seemingly overshadowed interesting behavioral stabilization and alterations of Abeta burden in these and other vaccinated patients, thus speaking to the potential of immunotherapy for AD. Understanding the mechanisms by which vaccines reduce Abeta burden in AD brain and the types of immune responses raised, as well as developing new modalities of vaccine delivery that facilitate the modulation of elicited immune responses, will undoubtedly lead to a new generation of efficacious Abeta immunotherapeutics with improved safety profiles.     

Migrant labor and sexually transmitted disease: AIDS in Africa

Acquired immune deficiency syndrome (AIDS) is worldwide, but the clinical and epidemiological pattern of the disease in Africa is different from that in developed areas. "Type 1 AIDS" occurs in industrialized North America and Europe; it has a distinctive sex ratio (16:1) and risk pattern of IV drug use and sexual practices. "Type 2 AIDS" occurs in Third World countries, particularly in eastern, southern, and central Africa. It is characterized by an entirely different sex ratio (1:1) and by distinctively different risk patterns. Both epidemics are caused by the HIV-1 virus. The key concept for understanding the origins of the differences between Type 1 and Type 2 AIDS is the migratory labor system in eastern, central, and southern Africa. This system causes long absences, increased family breakdown, and increased numbers of sexual partners. Historically the organization of this labor market has created a population which suffers from epidemics of sexually transmitted diseases. These historical patterns are presented as evidence for the contemporary transmission of AIDS. When contemporary AIDS and HIV-1 seropositivity prevalence data are examined, a systematic temporal and geographic pattern emerges for the AIDS epidemic in Africa. Despite a paucity of good data, the prevalence data from eastern, central, and southern Africa support the thesis of migrant labor's role in the transmission of AIDS.     

Bringing Two Worlds Together: A Collaborative Interview With JoEllen Patterson

JoEllen Patterson is Professor in the Marital and Family Therapy Program at the University of San Diego. She is also an Associate Clinical Professor of Family Medicine and Psychiatry at the University of California, San Diego, directing a medical family therapy clinic embedded in a Family Medicine residency (equivalent to General Practice in New Zealand). She also works in Pediatrics and Reproductive Medicine at UCSD. At present her work involves training family therapy students and family medicine residents to do interdisciplinary work using a biopsychosocial model. Research suggests that our bodies are influenced by our mental health; our immune systems and cardiovascular systems seem especially susceptible to mind‐body interplay. JoEllen is particularly interested in how family functioning influences the mind‐body system. In 2003, JoEllen Patterson received a Fulbright Senior Scholars award to visit the Wellington School of Medicine and Health Sciences, and the Child, Adolescent and Family Service in Lower Hutt, New Zealand. She spent two weeks between the clinical service and the academic department, teaching, consulting and advising. I was lucky enough to arrange this posting and to spend time with her during it.