Toxoplasma-IgM and IgG-avidity in single samples from areas with a high infection rate can determine the risk of mother-to-child transmission

Anti-Toxoplasma IgG-avidity was determined in 168 serum samples from IgG- and IgM-positive pregnant women at various times during pregnancy, in order to evaluate the predictive value for risk of mother-to-child transmission in a single sample, taking the limitations of conventional serology into account. The neonatal IgM was considered the serologic marker of transmission. Fluorometric tests for IgG, IgM (immunocapture) and IgG-avidity were performed. Fifty-one of the 128 pregnant women tested gave birth in the hospital and neonatal IgM was obtained. The results showed 32 (62.75%) pregnant women having high avidity, IgM indexes between 0.6 and 2.4, and no infected newborn. Nineteen (37.25%) had low or inconclusive avidity, IgM indexes between 0.6 and 11.9, and five infected newborns and one stillbirth. In two infected newborns and the stillbirth maternal IgM indexes were low and in one infected newborn the only maternal parameter that suggested fetal risk was IgG-avidity. In the present study, IgG-avidity performed in single samples from positive IgM pregnant women helped to determine the risk of transmission at any time during pregnancy, especially when the indexes of the two tests were analysed with respect to gestational age. This model may be less expensive in developing countries where there is a high prevalence of infection than the follow-up of susceptible mothers until childbirth with monthly serology, and it creates a new perspective for the diagnosis of congenital toxoplasmosis.

Analysis of mental health service financial models with a particular emphasis of Ireland

ABSTRACT: Financing is a critical factor in ensuring the optimal development and delivery of a mental health system. The primary method of financing worldwide is tax-based. However many low income countries depend on out-of-pocket payments. There is a report on Irish Health Care funding but none that deals exclusively with mental health care. This paper analyses the various financial models that exist globally with respect to financing the mental health sector, examines the impact of various models on service users, especially in terms of relative ‘financial burden’ and provides a more detailed examination of the current mental health funding situation in Ireland After extensive internet and hardcopy research on the above topics, the findings were analysed and a number of recommendations were reached. Mental health service should be free at the point of delivery to achieve universal coverage. Government tax-based funding or mandatory social insurance with government top-ups, as required, appears the optimal option, although there is no one funding system applicable everywhere. Out-of-pocket funding can create a crippling financial burden for service users. It is important to employ improved revenue collection systems, eliminate waste, provide equitable resource distribution, ring fence mental health funding and cap the number of visits, where necessary. Political, economic, social and cultural factors play a role in funding decisions and this can be clearly seen in the context of the current economic recession in Ireland. Only 33% of the Irish population has access to free public health care and the number health insurance policy holders has dramatically declined, resulting in increased out-of-pocket payments. This approach risks negatively impacting on the social determinants of health, increasing health inequalities and negatively affecting economic productivity. It is therefore important the Irish government examines other options to provide funding for mental health services.

Expressão e purificação da proteína E3 do vírus chikungunya (CHIKV)

RESUMO: O vírus chikungunya (CHIKV) é um vírus de RNA, com invólucro, da família Togaviridae, transmitido por mosquitos Aedes spp. Distribuído por largas regiões de África e Ásia, causa grandes epidemias de artrite grave. A semelhança de sintomas com outras doenças como a dengue e a malária e a persistência de IgM específicas, dificultam o diagnóstico da infeção por CHIKV. A deteção no sangue de E3, uma glicoproteína viral secretada, a incluir num ensaio imunoenzimático poderá melhorar o diagnóstico nos países onde as técnicas de biologia molecular são de difícil acesso. Para testar a utilidade de E3 num ensaio de diagnóstico, esta deverá ser expressa em quantidade, purificada e usada para produção de anticorpos específicos. Para expressar E3 numa forma solúvel, suscetível de ser purificada num único passo cromatográfico sem proteases, recorreu-se à estratégia da fusão com o domínio de ligação à quitina (CBD)-inteína (IMPACT™ System, NEB). A sequência codificadora de E3 foi amplificada a partir de RNA viral, clonada em pTYB21 e expressa em E. coli como uma proteína de fusão insolúvel de 64 kDa. A expressão a 12ºC induzida por IPTG 0,1 mM aumentou a solubilidade de CBD-inteína-E3. A aplicação de lisados celulares em colunas de quitina originou a retenção de CBD-inteína-E3 na matriz. Porém, a autoclivagem da inteína na coluna, induzida com reagentes tiol, foi pouco eficiente e mesmo a proteína E3 separada não eluiu da coluna. E3 foi ainda expressa em E. coli com uma cauda de seis histidinas (E3[His]6) por clonagem no vetor pET28b(+). Lisados celulares aplicados em colunas de níquel permitiram a eluição de uma proteína de 9 kDa, compatível com a massa molecular estimada para E3[His]6, ainda que com outros contaminantes proteicos. A identidade da proteína de 9 kDa será confirmada pela indução de anticorpos com esta preparação e reatividade daqueles com células infetadas com CHIKV.----------------ABSTRACT: Chikungunya virus (CHIKV) is an enveloped, positive strand RNA virus belonging to the family Togaviridae. Transmitted by Aedes spp mosquitoes, CHIKV causes large epidemics of severe arthritogenic disease in Africa and Asia and represents a serious threat in countries where vectors are present. Symptoms similarity with other diseases, e.g. dengue and malaria, along with CHIKV IgM persistence turns accurate CHIKV diagnosis a difficult task in low-income countries. Detection of E3, a small secreted viral glycoprotein, to be included in an immunoenzymatic test was envisaged as a possible improvement in CHIKV diagnosis. To test the diagnostic value of E3, recombinant E3 should be expressed and purified to generate antibodies. In order to express CHIKV E3 in a soluble form amenable to purification by a single step affinity chromatography, the chitin binding domain (CBD)-intein fusion strategy without proteases (IMPACT™ System, NEB) was employed. The E3 coding sequence was amplified from viral RNA, cloned in pTYB21 and expressed in E. coli ER2566 as an insoluble 64 kDa CBD-intein-E3 fusion protein. Solubility was partially achieved by lowering the expression temperature to 12ºC and the inducer (IPTG) concentration to 0.1 mM. Clarified cell lysate loaded onto a chitin column allowed ligation of the fusion protein but the intein-mediated cleavage efficiency was low and E3 failed to elute from the column as demonstrated by SDS-PAGE. E3 was further expressed with a six histidine tag, E3[His]6, employing the pET System (Novagen). E3[His]6 was expressed in E. coli Rosetta (30ºC, 0.4 mM IPTG) as a 9 kDa protein. Soluble cell extracts in 20-40 mM imidazole, applied onto a nickel column and eluted with 500 mM imidazole yielded a protein preparation enriched in the 9kDa protein. The 9 kDa will be used as antigen to generate antibodies that upon reaction with CHIKV infected cells will confirm its identity.

Perfil sociodemográfico e saúde mental em cuidadores informais de idosos no município de São Paulo-Brasil: desafios para as políticas públicas

RESUMO: INTRODUÇÃO: O rápido envelhecimento populacional, o aumento da prevalência de transtornos neuropsiquiátricos, o aumento das taxas de morbilidade clínica e incapacidade entre idosos de países em desenvolvimento têm trazido preocupações sobre a saúde mental e sobrecarga de cuidadores informais. Está bem estabelecida a elevada prevalência de transtornos mentais comuns (TMC) associada à adversidade socioeconômica, baixo nível educacional, estresse e gênero. Idosos e cuidadores vivendo em comunidade compartilham fatores de risco para morbilidade física e psiquiátrica. Adicionalmente, os cuidadores tem uma tripla carga, sendo simultaneamente familiares, trabalhadores leigos em saúde sem suporte dos serviços de saúde e assistência social e um paciente com necessidades não atendidas. O cuidador informal é o principal provedor de cuidado em todos os países. OBJETIVOS: Acessar perfil sociodemográfico, níveis de transtorno mental comum (TMC) e sobrecarga em cuidadores, características do cuidado e prevalência de demência e depressão no idosos, numa área carente da região oeste de São Paulo –Brasil. MÉTODO: Esta pesquisa transversal deriva do São Paulo Ageing and Health Study (SPAH) que incluiu idosos com 65 anos ou mais e seus respectivos cuidadores. Os participantes foram identificados por arrolamento domiciliar e entrevistadas em suas casas com protocolo padronizado de pesquisa. O instrumento utilizado para acessar os transtornos mentais comuns, foi o Self Rating Questionnaire SRQ-20.A sobrecarga foi quantificada pelo Zarit Caregiver Burden Scale. Diagnósticos psicogeriátricos foram mensurados através do SRQ-20 e critérios do CID-10 e do DSM-IV. 8 RESULTADOS: 588 cuidadores e respectivos idosos foram incluídos. Nos idosos, a prevalência de demência foi 15,9%, de depressão pelo CiD-10 9.9% e de TMC 39,25% Nos cuidadores, a prevalência de TMC foi de 55,1% e 32,8% dos cuidadores apresentaram sobrecarga elevada. O perfil do cuidador foi filha,com idade em torno dos 49 anos, casada e com baixo nível educacional.------------------ABSTRACT: BACKGROUND: With the fast population aging, growing prevalence of neuropsychiatric disorders, clinical morbidity and disability among the elderly particularly in low income countries (LAMIC), has brought concerns about informal caregiver Mental Health and Burden. It is well established the high prevalence of Common Mental Disorders (CMD) associated to socioeconomic adversity, low educational attainment, stress and gender. Community-dwelling elders and caregivers share risk factors for physical and psychiatric morbidity. In addition, caregivers have a triple strain, being simultaneously, family members, lay health workers with lack of support from health and social work services and a hidden patient with unmet needs. The world main source of caregiving relies on informal caregiver. AIMS: To assess 1) the sociodemographic profile, levels of CMD and burden among caregivers, and 2) the characteristics of care and prevalence of dementia and depression in elderly in a socioeconomic underprivileged area in western region of Sao Paulo – Brazil. METHOD: The present investigation is a cross-sectional part of Sao Paulo Ageing and Health Study (SPAH) which included participants aged 65 or older and their respective caregivers. Participants were identified by household enrollment and interviewed in their homes using a standardized research protocol. The assessment of common mental disorders was performed with the Self Rating Questionnaire – 20 (SRQ-20), used to establish psychiatric caseness. The assessment of burden was performed with Zarit Caregiver Burden Scale. Dementia and psychogeriatric diagnosis were reached through ICD-10, SRQ-20 and DSM-IV criteria. 10 RESULTS: 588 caregivers and respective elderly relatives were included. Prevalence of dementia was 15.9%, ICD-10 depression 9.9% and CMD 39.3% among the elderlys. Common mental disorder prevalence in caregivers was 55.1% and high burden was reached in 32.8% of the caregiver sample. Most of the caregivers were married and co-resident daughters with a mean age of 49 years (CI 95% - 48.7 to 51).

Indexing and active fund management: International evidence

Author's pre-print

Biological, behavioral, and socioeconomic factors associated with death from AIDS in Brasília, Brazil, in 2007

INTRODUCTION: In the jurisdiction of Brasília, Brazil, significant reductions in mortality rates and lethality resulting from acquired immunodeficiency syndrome (AIDS) were observed shortly after the introduction of highly active antiretroviral therapy. In recent years, however, the decline of these rates has not been as significant. Non-adherence to treatment and delayed diagnosis appear to be the main factors that increase the risk of death from AIDS. Behavioral, socioeconomic, and biological factors could also be associated with increased risk of death due to AIDS. This study aimed to identify which of these factors were associated with deaths from AIDS in Brasília. METHODS: A case-control study was undertaken using the data recorded in the Information System of Notifiable Diseases. Cases consisted of AIDS deaths occurring in 2007, residing in Brasília, and over 12 years of age. Controls consisted of AIDS patients who did not die until December 31 2007, also residing in Brasília, and over 12 years of age. For each group, frequency and proportion tables for the variables were prepared. The statistical association of each factor in isolation with the occurrence of the deaths was verified through a model of multivariate analysis using logistic regression. RESULTS: The factors that were associated with an increased risk of death were intravenous drug use, age 50 years or more, and residing in a region whose residents have low per capita income. CONCLUSIONS: We identified factors associated with death due to AIDS that can guide health planning.

National suicide prevention strategy for Afghanistan (NSPS)

RESUMO: Do suicídio no Afeganistão é uma prioridade de saúde pública. O Afeganistão é um país de baixo rendimento, emergindo de três décadas de conflitos. Há uma alta prevalência de sofrimento psicológico, perturbações mentais e abuso de substâncias. Existem várias questões sociais, tais como, desequilíbrio/violência de género, pobreza, atitudes e costumes obsoletos, rápidas mudanças sócio-culturais, violação dos direitos humanos e especialmente dos direitos das mulheres e das crianças. Estes fatores de risco contribuem para o aumento da vulnerabilidade da população em relação ao suicídio. A relativa alta taxa de suicídio no Afeganistão é especialmente significativa comparada com as taxas baixas em todos os países islâmicos. Os estudos mostraram predominância de suicídio nas mulheres (95%) e em pessoas jovens. Existe, por isso, uma necessidade urgente do país ter uma estratégia de prevenção do suicídio. A estratégia foi desenvolvida pela criação de um grupo técnico/ de assessoria multi-sectorial de diferentes intervenientes tais como governo, ONGs, agências doadoras, as famílias das vítimas e outraas partes interessadas. A estratégia baseia-se os seguintes valores chave:, respeito pelas diversidades; sensibilidade para as questões sócio-cultura-religiosa e de género; promoção da dignidade da sociedade; respeito pelos direitos humanoss.. Os 'seis pontos estratégicos' são: envolvimento das principais partes interessadas e criação de colaboração intersectorial coordenada; fornecimento de cuidados às pessoas que fazem tentativas de suicídio e às suas famílias; melhoria dos serviços para pessoas com doença mental e problemas psicossociais; promover uma comunicação e imagem adequada dos comportamentos suicidas, pelos meios de comunicação; reduzir o acesso aos meios de suicídio e coligir informação sobre as taxas de suicídio, os fatores de risco, os fatores protetores e as intervenções eficazes. A estratégia nacional de prevenção do suicídio será inicialmente implementada por 5 anos, com uma avaliação anual do plano de acção para entender os seus pontos fortes e limitações. Recomendações e sugestões serão incorporadas nos próxima planos anuais para uma intervenção eficaz. Um sistema de monitorização irá medir o progresso na implementação da estratégia.-----------------------------ABSTRACT: Suicide in Afghanistan is a public health priority. Afghanistan is a low-income country, emerging from three decades of conflicts. There is high prevalence of mental distress, mental disorders and substance abuse. There are multiple social issues, such as gender imbalance/violence, poverty, obsolete attitudes and customs, rapid social-cultural changes, human right violations, and especially women and children rights. These risk factors contribute to increase the vulnerability of the population for suicide. The relative high rate of suicide in Afghanistan is especially significant as the rates are low in all Islamic countries. Research studies have shown predominance of suicide in women (95%) and in young age people. There is an urgent need for the country to have a suicide prevention strategy. The strategy has been developed by establishing a multi-sectoral technical/advisory group of different stakeholders from government, NGOs, donor agencies, victim’s families, and interested parties. The strategy is based on the following key values, namely, respect for diversities; sensitiveness to socio-culture-religious and gender issues; promotion of the society dignity and respect for the human rights of people. The six ‘Strategic directions’ are: involving key stakeholders and creating coordinated inter-sectoral collaboration; providing after care for people making a suicide attempt and their families; improving services for people with mental disorders and psycho-social problems; promoting the safe reporting and image of suicidal behaviour by media; reducing access to the means of suicide and gathering information about suicide rates, risk factor, protective factors and effective interventions. The National Suicide Prevention Strategy will be initially implemented for 5 years, with an annual evaluation of the action plan to understand the strengths and limitations. Recommendations and suggestions will be incorporated into the next annual plans for effective intervention. A monitoring framework will measure progress in implementing the strategy.

Relation between oral health and socioeconomic variables among schoolchildren aged 12 in the City of Manaus - AM

Studies have shown that the age of 12 was determined as the age of global monitoring of caries for international comparisons and monitoring of disease trends. The aimed was to evaluate the prevalence of dental caries, fluorosis and periodontal condition and their relation with socioeconomic factors among schoolchildren aged twelve in the city of Manaus, AM. This study with a probabilistic sample of 661 children was conducted, 609 from public and 52 from private schools, in 2008. Dental caries, periodontal condition and dental fluorosis were evaluated. In order to obtain the socioeconomic classification of each child (high, upper middle, middle, lower middle, low and lower low socioeconomic classes), the guardians were given a questionnaire. The mean decayed teeth, missing teeth, and filled teeth (DMFT) found at age twelve was 1.89. It was observed that the presence of dental calculus was the most severe periodontal condition detected in 39.48%. In relation to dental fluorosis, there was a low prevalence in the children examined, i.e., the more pronounced lines of opacity only occasionally merge, forming small white areas. The study showed a significant association of 5% among social class with dental caries and periodontal condition. In schoolchildren of Manaus there are low mean of DMFT and fluorosis, but a high occurrence of gingival bleeding.

Elevated Blood Pressure and Obesity in Childhood: A Cross-Sectional Evaluation of 4,609 Schoolchildren

Background: The incidence of obesity in children is increasing worldwide, primarily in urbanized, high-income countries, and hypertension development is a detrimental effect of this phenomenon. Objective: In this cross-sectional study, we evaluated the prevalence of excess weight and its association with high blood pressure (BP) in schoolchildren. Methods: Here 4,609 male and female children, aged 6 to 11 years, from 24 public and private schools in Maringa, Brazil, were evaluated. Nutritional status was assessed by body mass index (BMI) according to cutoff points adjusted for sex and age. Blood pressure (BP) levels above 90th percentile for gender, age and height percentile were considered elevated. Results: The prevalence of excess weight among the schoolchildren was 24.5%; 16.9% were overweight, and 7.6% were obese. Sex and socioeconomic characteristics were not associated with elevated BP. In all age groups, systolic and diastolic BP correlated with BMI and waist and hip measurements, but not with waist-hip ratio. The prevalence of elevated BP was 11.2% in eutrophic children, 20.6% in overweight children [odds ratio (OR), 1.99; 95% confidence interval (CI), 1.61-2.45], and 39.7% in obese children (OR, 5.4; 95% CI, 4.23-6.89). Conclusion: Obese and overweight children had a higher prevalence of elevated BP than normal-weight children. Our data confirm that the growing worldwide epidemic of excess weight and elevated BP in schoolchildren may also be ongoing in Brazil.

Human capital in export-based internationalisation. "Managerial determinants and their influence upon the export behaviour of the firm: four case-studies of catalan exporting SMEs"

Export activities are a major source of economic growth and are considered important both at the national level and for individual businesses. Moreover, in the case of SMEs, they gain particular relevance, exporting being the most common foreign market entry mode for these firms. The decision maker’s role in the export activity is crucial, particularly in the case of SMEs. However, the extant literature on internationalization is characterized by a lack of consensus among scholars as to what constitutes the managerial factor in determining exporting. Therefore, this study focuses on the following issue: Which are the decision maker’s characteristics and perceptions that may influence the export behaviour of Catalan SMEs? To address this question a multiple case study method is applied across four Catalan exporting SMEs. The methodology chosen for analysing the empirical data is relying on the proposition testing approach while the investigation is conducted including both within and cross-case analysis. The findings show that high educational level, language skills, high risk tolerance, innovativeness as well as strongly perceived export stimuli as compared to low and easy to overcome export barriers positively influence the export involvement and development of SMEs. The study provides further insights into the research topic by jointly studying managerial characteristics and perceptions. Additionally, the majority of research on exporting topics has been carried out in the USA, so there is a clear need of investigation in the field in other countries, moreover in Spain where the exporting activities have not been as widely studied.

The Social contract with endogenous sentiments

Moral values infuence individual behavior and social interactions. A specially signif- cant instance is the case of moral values concerning work e¤ort. Individuals determine what they take to be proper behaviour and judge the others, and themselves, accordingly. They increase their esteem -and self-esteem- for those who perform in excess of the standard and decrease their esteem for those who work less. These changes in self-esteem result from the self-regulatory emotions of guilt or pride extensively studied in Social Psychology. We examine the interactions between sentiments, individual behaviour and the social contract in a model of rational voting over redistribution where individual self-esteem and relative es-teem for others are endogenously determined. Individuals di¤er in their productivities. The desired extent of redistribution depends both on individual income and on individual attitudes toward others. We characterize the politico-economic equilibria in which sentiments, labor supply and redistribution are simultaneously determined. The model has two types of equilibria. In "cohesive" equilibria, all individuals conform to the standard of proper behav- iour, income inequality is low and social esteem is not biased toward any particular type. Under these conditions equilibrium redistribution increases in response to larger inequality. In a "clustered" equilibrium skilled workers work above the mean while unskilled workers work below. In such an equilibrium, income inequality is large and sentiments are biased in favor of the industrious. As inequality increases, this bias may eventually overtake the egoistic demand for greater taxation and equilibrium redistribution decreases. The type of equilibrium that emerges crucially depends on inequality. We contrast the predictions of the model with data on inequality, redistribution, work values and attitudes toward work and toward the poor for a set of OECD countries.

Ten Propositions on Rural Poverty and Agrarian Transition in Central Eurasia

The relation between agricultural development and rural poverty reduction in six Central Eurasian countries, namely Azerbaijan (South Caucasus) and Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan (Central Asia), is discussed by presenting and analyzing ten propositions. These propositions cover a broad range of issues that relate to rural poverty in this region, such as: the state of income and non-income poverty; the diverse processes of land reform and farm restructuring, and agricultural policy reform; and finally, the institutional and market framework that is needed for dynamic agricultural and rural development. The paper contends that rural poverty is not responding as robustly to rapid economic growth in these countries, and that agricultural growth, in particular in the newly emerging peasant farm sector, is necessary to promote rural poverty reduction.

Device-specific weighted T-score for two quantitative ultrasounds: operational propositions for the management of osteoporosis for 65 years and older women in Switzerland.

The World Health Organization (WHO) criteria for the diagnosis of osteoporosis are mainly applicable for dual X-ray absorptiometry (DXA) measurements at the spine and hip levels. There is a growing demand for cheaper devices, free of ionizing radiation such as promising quantitative ultrasound (QUS). In common with many other countries, QUS measurements are increasingly used in Switzerland without adequate clinical guidelines. The T-score approach developed for DXA cannot be applied to QUS, although well-conducted prospective studies have shown that ultrasound could be a valuable predictor of fracture risk. As a consequence, an expert committee named the Swiss Quality Assurance Project (SQAP, for which the main mission is the establishment of quality assurance procedures for DXA and QUS in Switzerland) was mandated by the Swiss Association Against Osteoporosis (ASCO) in 2000 to propose operational clinical recommendations for the use of QUS in the management of osteoporosis for two QUS devices sold in Switzerland. Device-specific weighted "T-score" based on the risk of osteoporotic hip fractures as well as on the prediction of DXA osteoporosis at the hip, according to the WHO definition of osteoporosis, were calculated for the Achilles (Lunar, General Electric, Madison, Wis.) and Sahara (Hologic, Waltham, Mass.) ultrasound devices. Several studies (totaling a few thousand subjects) were used to calculate age-adjusted odd ratios (OR) and area under the receiver operating curve (AUC) for the prediction of osteoporotic fracture (taking into account a weighting score depending on the design of the study involved in the calculation). The ORs were 2.4 (1.9-3.2) and AUC 0.72 (0.66-0.77), respectively, for the Achilles, and 2.3 (1.7-3.1) and 0.75 (0.68-0.82), respectively, for the Sahara device. To translate risk estimates into thresholds for clinical application, 90% sensitivity was used to define low fracture and low osteoporosis risk, and a specificity of 80% was used to define subjects as being at high risk of fracture or having osteoporosis at the hip. From the combination of the fracture model with the hip DXA osteoporotic model, we found a T-score threshold of -1.2 and -2.5 for the stiffness (Achilles) determining, respectively, the low- and high-risk subjects. Similarly, we found a T-score at -1.0 and -2.2 for the QUI index (Sahara). Then a screening strategy combining QUS, DXA, and clinical factors for the identification of women needing treatment was proposed. The application of this approach will help to minimize the inappropriate use of QUS from which the whole field currently suffers.

Associations between alcohol consumption and selected cytokines in a Swiss population-based sample (CoLaus study).

To assess the associations between alcohol consumption and cytokine levels (interleukin-1beta - IL-1β; interleukin-6 - IL-6 and tumor necrosis factor-α - TNF-α) in a Caucasian population. Population sample of 2884 men and 3201 women aged 35-75. Alcohol consumption was categorized as nondrinkers, low (1-6 drinks/week), moderate (7-13/week) and high (14+/week). No difference in IL-1β levels was found between alcohol consumption categories. Low and moderate alcohol consumption led to lower IL-6 levels: median (interquartile range) 1.47 (0.70-3.51), 1.41 (0.70-3.32), 1.42 (0.66-3.19) and 1.70 (0.83-4.39) pg/ml for nondrinkers, low, moderate and high drinkers, respectively, p<0.01, but this association was no longer significant after multivariate adjustment. Compared to nondrinkers, moderate drinkers had the lowest odds (Odds ratio=0.86 (0.71-1.03)) of being in the highest quartile of IL-6, with a significant (p<0.05) quadratic trend. Low and moderate alcohol consumption led to lower TNF-α levels: 2.92 (1.79-4.63), 2.83 (1.84-4.48), 2.82 (1.76-4.34) and 3.15 (1.91-4.73) pg/ml for nondrinkers, low, moderate and high drinkers, respectively, p<0.02, and this difference remained borderline significant (p=0.06) after multivariate adjustment. Moderate drinkers had a lower odds (0.81 [0.68-0.98]) of being in the highest quartile of TNF-α. No specific alcoholic beverage (wine, beer or spirits) effect was found. Moderate alcohol consumption is associated with lower levels of IL-6 and (to a lesser degree) of TNF-α, irrespective of the type of alcohol consumed. No association was found between IL-1β levels and alcohol consumption.

Union Mediation and Adaptation to Reciprocal Loyalty Arrangements

This study assesses the industrial relations application of the „loyalty-exit-voice‟ proposition. The loyalty concept is linked to reciprocal employer-employee arrangements and examined as a job attribute in a vignette questionnaire distributed to low and medium-skilled employees. The responses provided by employees in three European countries indicate that reciprocal loyalty arrangements, which involve the exchange of higher effort for job security, are one of the most desirable job attributes. This attribute exerts a higher impact on the job evaluations provided by unionised workers, compared to their non-union counterparts. This pattern is robust to a number of methodological considerations. It appears to be an outcome of adaptation to union mediated cooperation. Overall the evidence suggests that the loyalty-job evaluation profiles of unionised workers are receptive to repeated interaction and negative shocks, such as unemployment experience. This is not the case for the non-union workers. Finally, unionised workers appear to „voice‟ a lower job satisfaction, but exhibit low „exit‟ intentions, compared to the non-unionised labour.