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Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score >= 6/10 and 75% of respondents scoring >= 6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.

Labial salivary gland (LSG) biopsy is used in the classification of primary Sjögren's syndrome (PSS) and in patient stratification in clinical trials. It may also function as a biomarker. The acquisition of tissue and histological interpretation is variable and needs to be standardised for use in clinical trials. A modified European League Against Rheumatism consensus guideline development strategy was used. The steering committee of the ad hoc working group identified key outstanding points of variability in LSG acquisition and analysis. A 2-day workshop was held to develop consensus where possible and identify points where further discussion/data was needed. These points were reviewed by a subgroup of experts on PSS histopathology and then circulated via an online survey to 50 stakeholder experts consisting of rheumatologists, histopathologists and oral medicine specialists, to assess level of agreement (0-10 scale) and comments. Criteria for agreement were a mean score ≥6/10 and 75% of respondents scoring ≥6/10. Thirty-nine (78%) experts responded and 16 points met criteria for agreement. These points are focused on tissue requirements, identification of the characteristic focal lymphocytic sialadenitis, calculation of the focus score, identification of germinal centres, assessment of the area of leucocyte infiltration, reporting standards and use of prestudy samples for clinical trials. We provide standardised consensus guidance for the use of labial salivary gland histopathology in the classification of PSS and in clinical trials and identify areas where further research is required to achieve evidence-based consensus.

The family farm is a corner-institute of West European agriculture. This article highlights the main characteristics of the family farm and reviews both the socio-economic and political-institutional arguments used for the persistence of this structure in West European farming. At micro level, the socio-economic rationale behind the family farm states that economies of scale tend to increase the optimal farm size, but that this tendency is partly offset by the importance of transaction costs for monitoring labour results. Moreover, the flexibility of family labour, the accumulated human capital within the farming family and the ability to withstand hard (financial) times are factors in favour of the family farm. At macro level, the availability of food for the population has been one of the major concerns of policy makers. Different protectionist measures have been developed in order to secure enough food over time. Although the kind of farming system is not specified in these measures, the farm lobby has influenced the legislations in order to safeguard the current family farms. In the last decades the governmental concern has broadened due to environmental concerns. To reach these goals, the family farm approach is useful as family farms are essential for the kinds of landscape and rural social life. Taking into account the history of the family farm, the paper proposes different strategies, related to labour and capital allocation that can strengthen the survival of the family farm in the next decades.

This paper reports a comprehensive quantitative summary into applicant reactions to popular methods of employee selection. A detailed search of published and unpublished studies resulted in a final sample (k) of 38 independent samples covering 10 popular candidate assessment methods. Applicant reactions primary studies included samples from 17 countries internationally. Counter to previous suggestions for the situational specificity of applicant reactions, findings showed considerable similarity supporting the reaction generalizability hypothesis. Reaction favorability was structurally similar across countries and revealed a three-tier clustering of overall favorability perceptions - most preferred (work samples, interviews), favorably evaluated (resumes, cognitive tests, references, biodata, personality inventories), and least preferred (honesty tests, personal contacts, graphology). Some differences in applicant reactions to dimension-specific perceptions were found, however. Further analyses revealed strong positive correlations between favorability ratings and their validity and international usage. Implications for future research and ramifications for practice are considered in conclusion.

According to career construction theory, continuous adaptation to the work environment is crucial to achieve work and career success. In this study, we examined the relative importance of career adaptability for job performance ratings using an experimental policy-capturing design. Employees (N = 135) from different vocational backgrounds rated the overall job performance of fictitious employees in 40 scenarios based on information about their career adaptability, mental ability, conscientiousness, and job complexity. We used multilevel modeling to investigate the relative importance of each factor. Consistent with expectations, career adaptability positively predicted job performance ratings, and this effect was relatively smaller than the effects of conscientiousness and mental ability. Job complexity did not moderate the effect of career adaptability on job performance ratings, suggesting that career adaptability predicts job performance ratings in high-, medium-, and low-complexity jobs. Consistent with previous research, the effect of mental ability on job performance ratings was stronger in high- compared to low-complexity jobs. Overall, our findings provide initial evidence for the predictive validity of employees' career adaptability with regard to other people's ratings of job performance. (C) 2015 Elsevier Inc. All rights reserved.

Background-The common occurrence of xerostomia in Sjogren's syndrome (SS) as well as the easy accessibility of saliva supports the use of sialometry and sialochemistry in the diagnosis of SS. Collection and analysis of whole saliva (oral fluid) is currently the routine technique for sialometry, despite the fact that it is rather inaccurate and impure.Objective-To assess the value of glandular sialometry and sialochemistry as diagnostic instruments in SS.Methods-In a group of 100 consecutive patients referred for diagnosis of SS, glandular secretory flow rates and a spectrum of salivary components (sodium, potassium, chloride, calcium, phosphate, urea, amylase, total protein) were assessed. The patients were classified as positive or negative for SS according to the revised European classification criteria.Results-Patients with SS differed clearly from those who tested negative for SS, showing lower submandibular/sublingual (SM/SL) flow rates and an appreciably changed salivary composition of parotid and SM/SL saliva. Besides changes in salivary flow rate and composition, distinct sialometric profiles were observed, characteristic of either early or late salivary manifestation of SS, or of the xerogenic side effects of medication.Conclusions-Glandular sialometry and sialochemistry are not only useful tools for differentiating SS from other salivary gland disease in clinical practice, but they also have great potential as diagnostic criteria for SS, showing distinct sialometric and sialochemical changes as well as profiles. Being simple, safe (non-invasive), and sensitive (early disease detection), they have three major advantages over other oral tests for SS.

Little is known about factors determining the outcome of childhood asthma. The purpose of this longitudinal study was to assess the factors in childhood that determine the level of FEV1 in early adulthood in asthmatic individuals, and to examine factors associated with decline in FEV1 during adulthood. Between 1966 and 1969, 119 allergic asthmatic subjects aged 5 to 14 yr were studied (Visit 1). Of these subjects, 101 (85%) were reinvestigated at ages 22 to 32 yr (visit 2) and 32 to 42 yr (Visit 3). At the first survey and during follow-up, a standardized questionnaire was used, serum total IgE and peripheral blood eosinophils were measured, and physical examination, skin tests, lung function tests, and histamine challenge (provocative concentration causing a 10% decline in FEV1; PC10) tests were performed according to the same protocol. Multiple linear regression analyses were performed with FEV1 at Visit 2 and with the change of FEV1 from Visit 2 to Visit 3 as outcome variables. A low FEV1% predicted at Visit 1 and PC10 less than or equal to 16 mg/ml at Visit 1 were significantly associated with a lower level of FEV1 at Visit 2. Subjects who quit smoking and subjects who continued to use inhaled corticosteroids had a significantly smaller annual decline in FEV1 from Visit 2 to Visit 3, adjusted for attained level of FEV1 at Visit 2. In conclusion, bronchial hyperresponsiveness and a low level of lung function in childhood are independent risk factors for a low level of FEV1 in early adulthood. A smaller decline in FEV1 after ages 22 to 32 yr occurs in asthmatics who quit smoking and who continue to use inhaled corticosteroids. Our data stress the importance of studying intervention strategies for asthma in young childhood and early adulthood in order to prevent or postpone further lung function deficits.

Bronchial responsiveness (BR) is an important risk factor for the development and outcome of asthma. This study assessed childhood risk factors for both the severity of BR in adulthood and either improvement or worsening of BR over time. Finally, we studied cross-sectional risk factors of BR in adulthood. Between 1966 and 1969, 119 allergic asthmatic children (5-14 yr of age) were studied. Of these, 101 (85%) subjects were reinvestigated at age 22-32 yr (visit 2), and at age 32-42 yr (visit 3). Spirometry, PC10 histamine, skin tests, blood eosinophils, and serum total IgE were measured and a questionnaire was used. Higher FEV1 values in childhood were associated with less severe BR at age 32-42 yr independent of other potential risk factors. Larger increases in FEV1 values both from visit 1 to 2 and from visit 2 to 3, a longer time interval from visit 1 to 3, and having pets in childhood were associated with less severe BR at age 32-42 yr. The same factors were found to be associated with less deterioration of BR from visit 2 to 3. In nonsmokers a higher IgE level at visit 2 was a risk factor for an increase in BR. At age 32-42 yr, a low level of lung function and the presence of asthma symptoms were associated with more severe BR, and older age and having pets were associated with less severe BR. IgE was related to more severe BR only in nonsmokers. Conclusions: A lower lung function in childhood and less improvement in FEV1 over time were associated with more severe BR in adulthood.

Bronchial responsiveness (BR) is an important risk factor for the development and outcome of asthma. This study assessed childhood risk factors for both the severity of BR in adulthood and either improvement or worsening of BR over time. Finally, we studied cross-sectional risk factors of BR in adulthood. Between 1966 and 1969, 119 allergic asthmatic children (5-14 yr of age) were studied. Of these, 101 (85%) subjects were reinvestigated at age 22-32 yr (visit 2), and at age 32-42 yr (visit 3). Spirometry, PC10 histamine, skin tests, blood eosinophils, and serum total IgE were measured and a questionnaire was used. Higher FEV1 values in childhood were associated with less severe BR at age 32-42 yr independent of other potential risk factors. Larger increases in FEV1 values both from visit 1 to 2 and from visit 2 to 3, a longer time interval from visit 1 to 3, and having pets in childhood were associated with less severe BR at age 32-42 yr. The same factors were found to be associated with less deterioration of BR from visit 2 to 3. In nonsmokers a higher IgE level at visit 2 was a risk factor for an increase in BR. At age 32-42 yr, a low level of lung function and the presence of asthma symptoms were associated with more severe BR, and older age and having pets were associated with less severe BR. IgE was related to more severe BR only in nonsmokers. Conclusions: A lower lung function in childhood and less improvement in FEV1 over time were associated with more severe BR in adulthood.

The perception of breathlessness is a subject-related factor which is linked to respiratory disease, cardiac disease and overweight, We studied the distribution of breathlessness, its association with respiratory disease, cardiac disease and overweight, as well as its association with lung function, reversibility of airway obstruction ("reversibility") and peak expiratory how (PEF) variability in an elderly population.Data on breathlessness (rated with Borg scale), lung function, reversibility, PEF variability, respiratory symptoms, cardiac disease and overweight were collected in a random sample of 210 elderly (>55 yrs old) who participated in a physical fitness test, Individuals with a Borg score >0 were taken to have breathlessness.Subjects with a Borg score >0 (n=50, 24%) were three to five times more likely to have a low lung function and large reversibility than subjects with a Borg score of zero, independent of the presence of respiratory symptoms, cardiac disease or overweight, although these three factors were all associated with low lung function and a large reversibility and PEF variability, Reversibility was not associated with PEF variability whatsoever.In elderly individuals, breathlessness is frequently present. Assessment of breathlessness using the Borg-scale seems an important clinical measurement, because it is an important independent predictor of lung function impairment in the elderly.

Background Chronic mucus hypersecretion (CMH) is highly prevalent in smokers and associated with an accelerated lung function decline and chronic obstructive pulmonary disease (COPD). Several risk factors contribute to CMH and to COPD. It is, however, unknown if risk factors for CMH are similar in persons with and without COPD.Methods 1479 persons with and 8529 without COPD, participating in the general population-based LifeLines cohort, completed questionnaires and underwent spirometry. Occupational exposure was assessed using the ALOHA+ job exposure matrix. Analyses were performed using multiple logistic regression models.Results In COPD, a significantly higher risk for CMH was associated with higher pack-years smoking (per 10 pack-years) (OR=1.28; 1.12 to 1.46) and environmental tobacco smoke (ETS) (OR=2.06; 1.33 to 3.19). In non-COPD; male gender (OR=1.91; 1.51 to 2.41), higher Body Mass Index (OR=1.04; 1.01 to 1.06), higher pack-years smoking (OR=1.28; 1.14 to 1.44), current smoking (OR=1.50; 1.04 to 2.18), low and high exposure to mineral dust (OR=1.39; 1.04 to 1.87 and OR=1.60; 1.02 to 2.52), high exposure to gases & fumes (OR=2.19; 1.49 to 3.22). Significant interactions were found between COPD and exposure to gases & fumes (p=0.018) and aromatic solvents (p=0.038).Conclusions A higher risk for CMH was associated with higher pack-years smoking regardless of COPD status. However, a higher risk for CMH was associated with high occupational exposure to gases & fumes in individuals without COPD only.

Background Lung growth in utero and lung function loss during adulthood can be affected by exposure to environmental tobacco smoke (ETS). The underlying mechanisms have not been fully elucidated. Both ETS exposure and single nucleotide polymorphisms (SNPs) in Glutathione S-Transferase (GST) Omega genes have been associated with the level of lung function. This study aimed to assess if GSTO SNPs interact with ETS exposure in utero and during adulthood on the level of lung function during adulthood. Methods We used cross-sectional data of 8,128 genotyped participants from the LifeLines cohort study. Linear regression models (adjusted for age, sex, height, weight, current smoking, ex-smoking and packyears smoked) were used to analyze the associations between in utero, daily and workplace ETS exposure, GSTO SNPs, the interaction between ETS and GSTOs, and level of lung function (FEV1, FEV1/FVC). Since the interactions between ETS and GSTOs may be modified by active tobacco smoking we additionally assessed associations in never and ever smokers separately. A second sample of 5,308 genotyped LifeLines participants was used to verify our initial findings. Results Daily and workplace ETS exposure was associated with significantly lower FEV1 levels. GSTO SNPs (recessive model) interacted with in utero ETS and were associated with higher levels of FEV1, whereas the interactions with daily and workplace ETS exposure were associated with lower levels of FEV1, effects being more pronounced in never smokers. The interaction of GSTO2 SNP rs156697 with in utero ETS associated with a higher level of FEV1 was significantly replicated in the second sample. Overall, the directions of the interactions of in utero and workplace ETS exposure with the SNPs found in the second (verification) sample were in line with the first sample. Conclusions GSTO genotypes interact with in utero and adulthood ETS exposure on adult lung function level, but in opposite directions.

Agenda-setting in the EU has been largely approached using literature from US scholars that emerged over the last 35 years. Surprisingly perhaps, grand theory in European integration has been ignored, even though it might offer valuable insights for longitudinal studies, particularly where issues have had difficulty making it onto the policy agenda. This article seeks to reconcile neofunctionalist and agenda-setting literature, to trace the journey towards agenda-setting, a process through which venues and images play a crucial role over time in framing competing issues. It puts forward a combined framework for analysing agenda-setting dynamics, before applying it to examine a policy case over five decades. Tracing the 'issue career' of Community rail infrastructure upwards onto the EU's policy agenda, it shows how strategies to gain attention and build credibility mediate latent spillover pressures in order to secure agenda-setting change.

Regulations in the Netherlands with respect to nutrient use force dairy farmers to improve nutrient management at the whole-farm level. On experimental farm ‘De Marke’, a coherent set of simple measures at farm level has been implemented, which has resulted in a drastic reduction in input of nutrients without affecting production intensity (milk production; kg milk per ha). To promote adoption of these measures in commercial dairy farming, the project ‘Cows & Opportunities’ was initiated in which 16 commercial pilot farms participated. Data were collected over a 6-year period (1998–2003). This paper describes and analyses the different farm management strategies adopted on these farms, using two classifications of the farms at the start of the project (the base situation), one based on nitrogen (N) surplus (kg ha−1), the other on production intensity. In both classifications, the farms were split in two equal groups. Changes over time in farm characteristics (farm development) were described through linear regression for each group and the variance among farms within a group was used to test for differences between groups. Under the influence of economic driving forces, the pilot farms, on average, expanded land area and increased their milk quota. However, the most intensive farms could comply with regulations only by reducing production intensity. From 1998 to 2002, average nutrient surpluses on the pilot farms decreased by 33% for N and 53% for phosphorus (P). Important measures were reducing the use of inorganic fertilizer, optimizing the use of home-produced organic manure, reducing grazing time, reducing the number of replacement stock and lowering crude protein content in the ration. Over the years, variation in N surpluses among farms (inter-farm variation) remained almost constant. Differences in farm management strategy could not unequivocally be related to farm typology (high/low N surplus; high/low production intensity). It was concluded that decisions by individual farmers on farm development are not always based on ‘rational’ arguments, but are co-determined by ‘emotional’ perceptions.

This paper reports a comprehensive quantitative summary into applicant reactions to popular methods of employee selection. A detailed search of published and unpublished studies resulted in a final sample (k) of 38 independent samples covering 10 popular candidate assessment methods. Applicant reactions primary studies included samples from 17 countries internationally. Counter to previous suggestions for the situational specificity of applicant reactions, findings showed considerable similarity supporting the reaction generalizability hypothesis. Reaction favorability was structurally similar across countries and revealed a three-tier clustering of overall favorability perceptions - most preferred (work samples, interviews), favorably evaluated (resumes, cognitive tests, references, biodata, personality inventories), and least preferred (honesty tests, personal contacts, graphology). Some differences in applicant reactions to dimension-specific perceptions were found, however. Further analyses revealed strong positive correlations between favorability ratings and their validity and international usage. Implications for future research and ramifications for practice are considered in conclusion.

Airways obstruction and airways hyperresponsiveness are two dominant features in patients with chronic nonspecific lung disease (asthma and chronic obstructive pulmonary disease (COPD)). We set up a study to determine whether long-term (3 yrs) therapeutic intervention directed at airways obstruction and hyperresponsiveness is superior to one directed at airways obstruction alone. Patients were selected on functional criteria (age, baseline forced expiratory volume in one second (FEV1), and airways hyperresponsiveness) and, furthermore, extensively characterized by history, smoking habits, allergy, reversibility of airways obstruction and quality of life. The methodology and practical problems of setting up this large multicentre study are outlined, together with an analysis of baseline data.Standardization of methods and techniques and recruitment of patients required much effort, recruitment taking about twice as long as expected. A 3 month feasibility study allowed us to eliminate minor problems in the protocol.Over a 16 month period, 274 adult patients (18-60 yrs) from the out-patient clinics of six university centres entered the study; 99 met the diagnostic criteria for asthma, 51 for COPD, 88 for asthmatic bron-chitis, and 36 could not be classified. Their mean (SD) FEV % pred was 65.1 (15.2)%. Their geometric mean provoking concentration of histamine producing a 20% fall in FEV1 (PC20 histamine) was 0.28 mg.ml-1. In a multiple regression analysis, more severe airways hyperresponsiveness was associated with lower prechallenge FEV % pred (p We conclude that setting up long-term multicentre trials in chronic non-specific lung disease (CNSLD) is feasible and that these may offer valuable information on treatment and outcome of the disease.

Objectives High microbial exposures in farmers and agricultural workers are associated with less atopy. Although it has been speculated that healthy worker survival could be an explanation, this has not been studied so far. Therefore, we investigated the presence of healthy worker survival in a five-year follow-up study of an occupational cohort of Dutch farmers and agricultural industry (company) workers. Methods We compared baseline demographic characteristics, respiratory health, atopy and endotoxin exposure of 259 workers followed up with 124 workers lost to follow-up. Additionally, baseline health status of 31 participants who had changed to lower exposure jobs at follow-up was compared to those with similar or higher exposure jobs at follow-up. Results In general, no major healthy worker survival effect was found. Nonetheless, small differences were observed between subjects included in follow-up and those lost to follow-up. Those lost to follow-up were older, had a lower peak expiratory flow, and were less often raised on a farm. Company workers lost to follow-up with a farm childhood had more often self-reported allergy, but this was not observed for subjects with atopic sensitization or other respiratory symptoms. No differences were found for any of the studied characteristics in participants with lower exposure at follow-up compared to participants with similar or higher exposure at follow-up. Conclusions No major healthy worker survival is present in this organic dust exposed cohort. Differences between participants lost to follow-up and participants included in follow-up with regard to health characteristics are small and unlikely to explain the previously reported inverse associations between endotoxin exposure and atopy. Electronic supplementary material The online version of this article (doi:10.1007/s00420-015-1047-9) contains supplementary material, which is available to authorized users.

BACKGROUND: Factors contributing to either "complete" or "clinical" remission of asthma are important to know since there is no cure for the disease.METHODS: A cohort of 119 allergic asthmatic children was examined three times with a mean follow up of 30 years. They were aged 5-14 years at visit 1 (1966-9), 21-33 years at visit 2 (1983-6), and 32-42 years at visit 3 (1995-6). Complete remission of asthma at visit 3 was defined as no asthma symptoms, no use of inhaled corticosteroids, normal lung function (FEV1 >90% predicted), and no bronchial hyperresponsiveness (PC10 >16 mg/ml). Clinical remission was defined as no asthma symptoms and no use of inhaled corticosteroids.RESULTS: 22% of the group was in complete remission of asthma at visit 3 and a further 30% was in clinical remission (total 52%); 57% of subjects in clinical remission had bronchial hyperresponsiveness and/or a low lung function. Logistic regression analyses showed that a higher FEV1 in childhood and more improvement in FEV1 from age 5-14 to 21-33 were associated with both complete and clinical asthma remission at age 32-42.CONCLUSIONS: Complete remission of asthma was present in a small subset of asthmatics while half the subjects showed clinical remission. Both complete and clinical remission were associated with a higher lung function level in childhood and a higher subsequent increase in FEV1. These results support the view that defining remission only on the basis of symptoms and medication use will overlook subjects with subclinical active disease and possibly associated airway remodelling.

A longitudinal cohort of 2,957 babies, born in 1975-1978, was used to investigate whether perinatal factors predict respiratory morbidity at a young adult age. In 1997, the presence of asthmatic (wheeze, nocturnal dyspnoea) and bronchitic (cough, phlegm, dyspnoea grade 3) symptoms and the level of lung function was determined in this cohort. The independent association between smoking during pregnancy, being first-born, birth weight and respiratory symptoms and lung function at young adult age was investigated using multiple regression models, taking other potential risk factors into account. Of 1,568 responders, 608 (39%, aged 18-22 yrs) had at least one respiratory symptom. The young adults who had a mother that smoked during pregnancy had a significantly lower level of lung function than their nonintra-uterine exposed peers (regression coefficient (B) (standard error): peak expiratory flow (PEF) -0.257 (0.131) L x s(-1); forced expiratory flow when 25% of the forced vital capacity has been exhaled (FEF25) -0.290 (0.129) L x s(-1)), although they were not at increased risk of having respiratory symptoms. Young adults who were first-born had better levels of lung function (B (SE): forced expiratory volume in one second (FEV1) 0.090 (0.042) L) and were less likely to have asthmatic symptoms (odds ratio (95%, confidence interval): 0.58 (0.35-0.95)) than those not first-born. Low birth weight (FEV1 -0.013 (0.004) L for a reduction of 100 g) was also predictive of reduced achieved levels of lung function at young adult age, independent of other potential risk factors, e.g. current smoking habits or familial predisposition. This study adds to the knowledge of the role of perinatal factors, such as smoking during pregnancy, as important predictors of respiratory morbidity.

Das vom Europäischen Gerichtshof (EuGH) in seinen Entscheidungen entwickelte Verbraucherleitbild des ?durchschnittlich informierter, aufmerksamer und verständiger Durchschnittsverbrauchers? wird in der vorliegenden Arbeit anhand von Befunden aus der Konsumentenforschung kritisch überprüft. Insbesondere wird der Frage nachgegangen, ob die Qualitätswahrnehmung bei Lebensmittelkäufen in der vom EuGH zugrunde gelegten Form real existiert oder lediglich eine Idealvorstellung darstellt. Zu diesem Zweck wird zunächst das Verbraucherleitbild des EuGH im Hinblick auf die Qualitätswahrnehmung bei Lebensmitteln analysiert und vom Leitbild des flüchtigen deutschen Durchschnittsverbrauchers abgegrenzt. Dem besseren Verständnis dient ein grober Überblick der rechtlichen Grundlagen, sowohl in Deutschland als auch in der EU. Die Besprechung von Forschungsergebnissen zur Qualitätswahrnehmung bei Lebensmitteln beschäftigt sich im ersten Teil mit grundlegenden Erkenntnissen zum Wahrnehmungs- und Informationsverhalten der Konsumenten. Dabei wird deutlich, dass es sich bei der Produktwahrnehmung des Verbrauchers um einen subjektiven und selektiven Vorgang handelt, den eine Vielzahl von Faktoren beeinflusst. Der Aufnahme und Verarbeitung aller angebotenen Informationen stehen sowohl die begrenzten Kapazitäten der Verbraucher als auch deren Entlastungsstreben entgegen. Die Betrachtung der speziellen Qualitätswahrnehmungsabläufe bei Lebensmitteln im zweiten Teil beginnt mit einer Abhandlung zum vielschichtigen und kontrovers diskutierten Begriff der Lebensmittelqualität. Das als objektiv angesehene, auf physiko-chemischen und sensorischen Analysen beruhende Verständnis der Lebensmittelqualität unterscheidet sich von der subjektiv wahrgenommenen Lebensmittelqualität, wie sie dem Verbraucher als Basis zur Präferenzbildung dient. Obwohl die Qualität eines Lebensmittels, bedingt durch die Vielzahl der einwirkenden Faktoren und die individuell unterschiedliche Meinungsbildung, von jedem Menschen anders gesehen wird, folgt der eigentliche Wahrnehmungsvorgang bestimmten Regeln und lässt sich theoretisch darstellen. Da nicht alle den Käufer interessierenden Produkteigenschaften zum Zeitpunkt des Kaufs zugänglich sind, bedient sich der Verbraucher sogenannter Qualitätsindikatoren. Durch den indirekten Charakter der Merkmalserfassung treten nachweislich Fehler auf, weshalb die Verbraucher die Beschaffenheit von Lebensmitteln vor einem Kauf nicht immer korrekt ermitteln. Hieraus kann sich eine falsche Produkterwartung ableiten, die unter Umständen zu einer veränderten Wahrnehmung des tatsächlichen Produkterlebnisses führt. Wenn solche Fehlperzeptionen bei nicht verifizierbaren Eigenschaften (sogenannten Glaubenseigenschaften) auftreten, lassen sie sich durch Produkterfahrungen, auch auf längere Sicht, nicht korrigieren. Begünstigt wird die Fehlbeurteilung von Lebensmitteln durch die Fülle und Unübersichtlichkeit des derzeitigen Informationsangebotes, welches die Kapazitäten der Verbraucher nur unzureichend berücksichtigt, sowie durch das Wissen der Anbieter um die Möglichkeiten, wie sie Wahrnehmungsverschiebungen herbeiführen. Obwohl eine steigende Qualitätsorientierung der Verbraucher besteht, wirken sich in der Regel auch qualitätsunabhängige Faktoren auf den Lebensmittelkauf aus. Neben bestimmten Gewohnheiten und sozialen Komponenten verhindern vor allem Kostenfaktoren, dass die präferierte Qualität erworben wird. Letzere umfassen neben finanziellen Auslagen auch Aufwendungen anderer Art, zum Beispiel zusätzlicher Zeitaufwand und Wege. Trotz erheblicher Informationsmengen und dem Empfinden einer tendenziell abnehmenden Qualität des Gesamtangebotes sehen sich die Verbraucher in den meisten Fällen als relativ kompetente Marktpartner und halten sich demnach für fähig, erfolgreiche Entscheidungen zu fällen. Verunsichernd wirken vermeintliche und reale Gesundheitsrisiken, denen die meisten Konsumenten aber mit einer zuversichtlichen Beurteilung ihrer persönlichen Risiken (?optimistic bias?) begegnen. Die kritische Überprüfung des Verbraucherleitbildes des EuGH ergibt, dass dem Käufer zwar durchaus ein verstärktes Interesse an Qualität und Qualitätsinformationen unterstellt werden darf, die vom EuGH vorausgesetzte Verständigkeit und Informiertheit unter den derzeitigen Bedingungen aber weit hinter der juristischen Fiktion zurückbleibt., The consumer model of an average consumer, who is reasonably well informed and reasonably observant and circumspect, which the European Court of Justice (EuGH) has developed in its decisions, is critically reviewed with the aid of results from consumer research. Of special interest is the question, whether the quality perception process of foodstuffs, as seen by the EuGH, represents reality or merely an ideal concept. First of all, the European Court?s consumer model is analyzed with respect to the quality perception of foodstuffs and differentiated from the consumer model of the careless German average consumer. For a better understanding a brief overview of the legal basis in Germany as well as in the European Community (EC) is given. The first section of the discussion from results of consumer research concerning the quality perception process of foods comprises basic findings about the way consumers acquire and process information. It becomes clear that product perception is a subjective and selective process, which is influenced by a large number of variables. The complete acquisition and processing of all the information offered is prevented by the limited capacities of consumers and their tendency to strive for relief. The second part, which deals with the specific quality perception process of foodstuffs, starts out with a discussion of the multifaceted and highly controversial concept of food quality. The objective understanding of food quality, which is based on physical, chemical and sensory analysis must be differentiated from the subjective perception of food quality as it serves the consumer in his/her purchasing preferences. Even though each individual due to the numerous factors influencing the quality perception and the individual way of attitude development sees the quality of foods differently, the actual process follows certain rules and can be theoretically described. As not all product characteristics of interest can be observed at the point of purchase, the consumer makes use of (so called) quality cues. Due to this indirect way of information gathering consumers make mistakes, and do not always deduce the true nature of a food product. This can result in false product expectations, which under certain circumstances may lead to an deluded product experience. If such misconceptions occur in connection with product characteristics, which cannot be verified (credence dimensions), correction of these misconceptions with the aid of product experience will be impossible even in the long run. False judgements are promoted by the abundance and complexity of the current information, which does not sufficiently take into acount the limited capabilities of buyers, and by the suppliers? knowledge of the possibility of intentionally shifting consumers? perception. Even though consumers show a growing quality consciousness, quality independent factors influence the food shopping behavior as well. Besides certain habits and social conditioning, the costs of food prevent people form getting their preferred quality. The cost factor comprises financial expenses as well as time and convenience expenditures. Despite considerable information and a feeling of diminishing quality of the food supply, consumers believe themselves to be quite competent and capable of making effective purchasing decisions. Concerns are caused by true and supposed health risks, which most consumers will however face with an optimistic bias regarding their personal risks. The critical review of the European Court?s consumer model reveals that the buyers do show a growing interest in food quality and accurate quality information, but that the consumer?s in their reasoning and knowledge do not, under current conditions, meet the expectations of the EuGH, that is the consumers remain significantly behind the judicial model.

Little is known about factors determining the outcome of childhood asthma. The purpose of this longitudinal study was to assess the factors in childhood that determine the level of FEV(1) in early adulthood in asthmatic individuals, and to examine factors associated with decline in FEV(1) during adulthood. Between 1966 and 1969, 119 allergic asthmatic subjects aged 5 to 14 yr were studied (Visit 1). Of these subjects, 101 (85%) were reinvestigated at ages 22 to 32 yr (Visit 2) and 32 to 42 yr (Visit 3). At the first survey and during follow-up, a standardized questionnaire was used, serum total IgE and peripheral blood eosinophils were measured, and physical examination, skin tests, lung function tests, and histamine challenge (provocative concentration causing a 10% decline in FEV(1); PC(10)) tests were performed according to the same protocol. Multiple linear regression analyses were performed with FEV(1) at Visit 2 and with the change of FEV(1) from Visit 2 to Visit 3 as outcome variables. A low FEV(1)% predicted at Visit 1 and PC(10)/= 16 mg/ml at Visit 1 were significantly associated with a lower level of FEV(1) at Visit 2. Subjects who quit smoking and subjects who continued to use inhaled corticosteroids had a significantly smaller annual decline in FEV(1) from Visit 2 to Visit 3, adjusted for attained level of FEV(1) at Visit 2. In conclusion, bronchial hyperresponsiveness and a low level of lung function in childhood are independent risk factors for a low level of FEV(1) in early adulthood. A smaller decline in FEV(1) after ages 22 to 32 yr occurs in asthmatics who quit smoking and who continue to use inhaled corticosteroids. Our data stress the importance of studying intervention strategies for asthma in young childhood and early adulthood in order to prevent or postpone further lung function deficits.

The perception of breathlessness is a subject-related factor which is linked to respiratory disease, cardiac disease and overweight, We studied the distribution of breathlessness, its association with respiratory disease, cardiac disease and overweight, as well as its association with lung function, reversibility of airway obstruction ("reversibility") and peak expiratory how (PEF) variability in an elderly population. Data on breathlessness (rated with Borg scale), lung function, reversibility, PEF variability, respiratory symptoms, cardiac disease and overweight were collected in a random sample of 210 elderly (>55 yrs old) who participated in a physical fitness test, Individuals with a Borg score >0 were taken to have breathlessness. Subjects with a Borg score >0 (n=50, 24%) were three to five times more likely to have a low lung function and large reversibility than subjects with a Borg score of zero, independent of the presence of respiratory symptoms, cardiac disease or overweight, although these three factors were all associated with low lung function and a large reversibility and PEF variability, Reversibility was not associated with PEF variability whatsoever. In elderly individuals, breathlessness is frequently present. Assessment of breathlessness using the Borg-scale seems an important clinical measurement, because it is an important independent predictor of lung function impairment in the elderly.

The aims of this study are: (1) to evaluate whether the estimates of the association of risk factors with bronchial hyperresponsiveness (BHR) depends on the accumulated dose administered in challenge tests; and (2) to verify whether a model developed for survival studies (Weibull regression) is suited to analyze methacholine dose-response curves. For these purposes, 863 challenge tests, from EC Respiratory Health Survey in Italy, up to a cumulative dose of 6 mg methacholine, were analyzed by Weibull regression and by traditional methods (logistic model and linear model), both before and after truncation of the curves at 2 mg. With all methods the main risk factors for BHR were respiratory symptoms and atopy while age and airway caliber exerted a protective action. Our results confirmed that in epidemiological surveys 2 mg methacholine is enough to fully appreciate the effect of risk factors on BHR and showed chat the Weibull model explains the observed variability better than linear and logistic regressions. (C) 1998 Elsevier Science Inc.

Airways obstruction and airways hyperresponsiveness are two dominant features in patients with chronic nonspecific lung disease (asthma and chronic obstructive pulmonary disease (COPD)). We set up a study to determine whether long-term (3 yrs) therapeutic intervention directed at airways obstruction and hyperresponsiveness is superior to one directed at airways obstruction alone. Patients were selected on functional criteria (age, baseline forced expiratory volume in one second (FEV1), and airways hyperresponsiveness) and, furthermore, extensively characterized by history, smoking habits, allergy, reversibility of airways obstruction and quality of life. The methodology and practical problems of setting up this large multicentre study are outlined, together with an analysis of baseline data. Standardization of methods and techniques and recruitment of patients required much effort, recruitment taking about twice as long as expected. A 3 month feasibility study allowed us to eliminate minor problems in the protocol. Over a 16 month period, 274 adult patients (18-60 yrs) from the out-patient clinics of six university centres entered the study; 99 met the diagnostic criteria for asthma, 51 for COPD, 88 for asthmatic bron-chitis, and 36 could not be classified. Their mean (SD) FEV % pred was 65.1 (15.2)%. Their geometric mean provoking concentration of histamine producing a 20% fall in FEV1 (PC20 histamine) was 0.28 mg.ml-1. In a multiple regression analysis, more severe airways hyperresponsiveness was associated with lower prechallenge FEV % pred (p

Objectives: To determine the performance of different tear and salivary tests applied in Sjogren's syndrome (SS) and to disclose how these tests relate to common serologic tests in SS.Design: In addition to the routine ocular and oral tests for diagnosing SS (Schirmer test, rose bengal score, unstimulated whole saliva flow, and parotid sialography), tear breakup time and flow rate of glandular saliva (parotid and submandibular-sublingual [SM/SL]) were evaluated in patients referred for diagnosis of SS. Patients were categorized into primary SS, secondary SS, and non-SS groups according to the revised European classification criteria for SS.Setting: Referral center. Patients: Referred sample of 80 consecutive patients.Main Outcome Measure: Correlation between ocular and salivary measures.Results: Breakup time;performed insufficiently in diagnosing SS, as opposed to the rose bengal score. In patients with primary and secondary SS, a clear correlation was noted between tear and saliva quality and secretion rate, and between the rose bengal score and parotid sialography. Increased rose bengal scores also correlated significantly with hyperglobulinemia and presence of SS-B antibodies in serum, with duration of subjective eye dryness, and with decreased tear-gland function. With regard to the,oral tests, whole, parotid, and SM/SL salivary flow decreased significantly with increasing duration of oral complaints, with the stimulated SM/SL flow rate showing the strongest decrease and being more specific in diagnosing SS. Also, parotid sialography was more specific in excluding patients without SS than the commonly applied diagnostic criterion of secretion of unstimulated whole saliva.Conclusions: The rose bengal score remains the eye test of choice, as it has the highest specificity for SS. Hyperglobulinemia and especially positive serologic findings for SS-B may warrant close monitoring of the eyes, since these serum findings appear to relate to the severity of ocular surface damage. Parotid sialography and stimulated secretion of SM/SL saliva are more specific in diagnosing SS than unstimulated. secretion of whole saliva.