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Abstract Aims Decision‐makers still predominantly focus on the perspective of non‐patient stakeholders, which may deviate from the unique perspective of heart failure (HF) patients. To enhance patient‐centred decision‐making, there is a need for more patient‐based evidence derived directly from the patients themselves. Hence, this study aimed to understand (i) HF patients' unmet medical needs and preferred treatment outcomes; (ii) patients' risk tolerance; and (iii) their information needs, uncertainties and satisfaction towards HF treatment. Methods This qualitative patient preference study consisted of a literature review with a systematic search strategy and semi‐structured interviews with HF patients, analysed using the framework method. During the interviews, patients were asked to rank a predefined list of disease and treatment‐related characteristics informed by the literature review and were able to spontaneously raise additional characteristics. Results The study included 14 Belgian HF patients (age range: 58–79, mean age: 72). (i) Regarding their unmet medical needs, HF patients reported that the most important unmet medical needs were shortness of breath and fatigue, as they negatively impact their quality of life (QoL) and independence. In the ranking exercise, patients prioritized improvements in QoL over improvements in life expectancy, whereby the following characteristics received the highest cumulative score: (1) independence, (2) shortness of breath, (3) impaired renal function, (4) survival, (5) fatigue, (6) risk of hospitalization and (7) communication with and between physicians. Patients most often spontaneously raise characteristics related to the general care process. Mechanism of action, route of administration, dose frequency and weight fluctuations scored among the least important characteristics. (ii) Regarding patients' risk tolerance towards HF treatment, some of the patients expressed zero tolerance for side effects, as they had not yet experienced any discomfort caused by the treatment or disease. (iii) Regarding their information needs, patients voiced their desire to receive practical and comprehensible advice orally from their physician because they highly value individualized treatment decision‐making. Patients also expressed uncertainties regarding whether the experienced effects were due to their treatment, disease, ageing or other comorbidities. Conclusions This study shows that, besides increasing life expectancy, HF patients prioritize improvements in symptoms and side effects reducing their QoL and independence, such as shortness of breath and fatigue. The patient‐relevant characteristics identified in this study, from the perspective of HF patients themselves, may be useful to inform clinical trial endpoint selection and guide downstream drug development, evaluation and clinical decision‐making towards addressing the unmet medical needs and treatment outcomes of importance to HF patients.

Manon Marquet, Pierre Missotten, Sarah Schroyen, Desiderate Nindaba, Stéphane Adam Psychology of Aging Unit, University of Liège, Liège, Belgium Background: Recent cross-cultural comparisons between Asian and Western cultures have shown that ageism arises more from the lack of availability of social and economic resources for older adults than from the culture itself. We tested this assumption by conducting a survey among people living in a least developed country compared with those living in a developed country.Participants and methods: Twenty-seven Belgians living in Belgium, 29 Burundians living in Belgium, and 32 Burundians living in Burundi were included in this study. Their attitudes toward older adults were assessed using several self-reported measures.Results: Statistical analyses confirmed that older people are more negatively perceived by Burundians living in Burundi than by Burundians and Belgians living in Belgium, whose attitudes did not differ from each other.Conclusion: Consistent with our hypothesis, our results suggest that the level of development of a country and more particularly the lack of government spending on older people (pension and health care systems) may contribute to their younger counterparts perceiving them more negatively. Keywords: attitudes toward older adults, cross-cultural differences, socioeconomic development, intergenerational relations

Sarah Schroyen,1 Stéphane Adam,1 Guy Jerusalem,2,3 Pierre Missotten1 1University of Liège, Psychology of Aging Unit, 2University of Liège, Laboratory of Medical Oncology, 3CHU Sart Tilman Liege, Department of Medical Oncology, Liège, Belgium Abstract: Cancer is a major health problem that is widespread in elderly people. Paradoxically, older people suffering from cancer are often excluded from clinical trials and are undertreated when compared to younger patients. One explanation for these observations is age stigma (ie, stereotypes linked to age, and thus ageism). These stigmas can result in deleterious consequences for elderly people’s mental and physical health in “normal” aging. What, then, is the impact in a pathological context, such as oncology? Moreover, health care professionals’ attitudes can be tainted with ageism, thus leading to undesirable consequences for patients. To counter these stigmas, we can apply some possible interventions emerging from research on normal aging and from social psychology, such as intergenerational contact, activation of positive stereotypes, self-affirmation, and so on; these tools can improve opinions of aging among the elderly people themselves, as well as health care professionals, thus affecting patients’ mental and physical health. Keywords: oncogeriatry, clinical approaches, stigmatization, ageism

Gilles P Squelard,1 Pierre A Missotten,1 Louis Paquay,2 Jan A De Lepeleire,2 Frank JVM Buntinx,2 Ovide Fontaine,1 Stephane R Adam,1 Michel JD Ylieff11Clinical Psychology of Ageing, Qualidem Research Project, University of Liège (ULg), Liège, Belgium; 2KU Leuven, Department of Public Health and Primary Care, Leuven, BelgiumBackground/aims: This study assesses and compares prevalence of psychological and behavioral symptoms in a Belgian sample of people with and without dementia.Methods: A total of 228 persons older than 65 years with dementia and a group of 64 non-demented persons were assessed using the Neuropsychiatric Inventory (NPI) in 2004.Results: Within the group without dementia, the most frequent symptoms were depression, agitation, and irritability. Within the group with dementia, the most common symptoms were depression, irritability, apathy, and agitation. Prevalence of delusions (P < 0.05), hallucinations (P < 0.05), anxiety (P < 0.05), agitation (P < 0.05), apathy (P < 0.01), aberrant motor behavior (P < 0.01), and eating disorders (P < 0.05) were significantly higher in the group with dementia.Conclusion: Depression, elation, irritability, disinhibition, and sleeping disorders are not specific to dementia. Agitation, apathy, anxiety, and delusions are more frequent in dementia but were not specific to the dementia group because their prevalence rates were close to 10% in the group without dementia. Hallucinations, aberrant motor behavior, and eating disorders are specific to dementia. The distinction between specific and nonspecific symptoms may be useful for etiological research on biological, psychological, and environmental factors.Keywords: behavior, behavior disorders, epidemiology, dementia, psychiatric symptoms, neuropsychiatry

Birdshot Uveitis (Birdshot) is a rare eye condition that affects HLA-A29-positive individuals and could be considered a prototypic member of the recently proposed 'MHC-I (major histocompatibility complex class I)-opathy' family. Genetic studies have pinpointed the endoplasmic reticulum aminopeptidase (ERAP1) and (ERAP2) genes as shared associations across MHC-I-opathies, which suggests ERAP dysfunction may be a root cause for MHC-I-opathies. We mapped the ERAP1 and ERAP2 haplotypes in 84 Dutch cases and 890 controls. We identified association at variant rs10044354, which mediated a marked increase in ERAP2 expression. We also identified and cloned an independently associated ERAP1 haplotype (tagged by rs2287987) present in more than half of the cases; this ERAP1 haplotype is also the primary risk and protective haplotype for other MHC-I-opathies. We show that the risk ERAP1 haplotype conferred significantly altered expression of ERAP1 isoforms in transcriptomic data (n = 360), resulting in lowered protein expression and distinct enzymatic activity. Both the association for rs10044354 (meta-analysis: odds ratio (OR) [95% CI]=2.07[1.58-2.71], P = 1.24 × 10(-7)) and rs2287987 (OR[95% CI]: =2.01[1.51-2.67], P = 1.41 × 10(-6)) replicated and showed consistent direction of effect in an independent Spanish cohort of 46 cases and 2103 controls. In both cohorts, the combined rs2287987-rs10044354 haplotype associated with Birdshot more strongly than either variant alone [meta-analysis: P=3.9 × 10(-9)]. Finally, we observed that ERAP2 protein expression is dependent on the ERAP1 background across three European populations (n = 3353). In conclusion, a functionally distinct combination of ERAP1 and ERAP2 are a hallmark of Birdshot and provide rationale for strategies designed to correct ERAP function for treatment of Birdshot and MHC-I-opathies more broadly.

Abstract Objective Several studies show that self‐perception of aging (SPA) is a significant predictor of mental and physical health. In this study, we analyze the effect of SPA on mortality in the specific context of geriatric oncology. Methods The sample constituted of 140 individuals aged 65 years and older suffering from a recent nonmetastatic cancer (breast, lung, gynecological, or hematological), followed up to 6 years. We used Cox proportional hazards model to assess the effect of SPA at baseline on mortality. It was adjusted for age, gender, educational and cognitive level, oncological information (the site and kind of cancer), number of comorbidities, and physical and mental health at baseline. Results Patients were aged 73 years at diagnosis and were more often women (85.7%). Individuals with more negative SPA were 3.62 times more likely to die than those with a more positive SPA, with control of gender, age, education and cognitive level, mental and physical health, the category (breast, lung, gynecological, or hematological), and kind (initial or recurrence) of cancer. Conclusions These findings suggest that SPA influence the mortality of older people in the particular context of oncology. Therefore, the need to change our attitudes toward aging and older people implied indirectly by these results is discussed.

Birdshot chorioretinopathy (BSCR) is a rare form of autoimmune uveitis that can lead to severe visual impairment. Intriguingly, >95% of cases carry the HLA-A29 allele, which defines the strongest documented HLA association for a human disease. We have conducted a genome-wide association study in 96 Dutch and 27 Spanish cases, and 398 unrelated Dutch and 380 Spanish controls. Fine-mapping the primary MHC association through high-resolution imputation at classical HLA loci, identified HLA-A*29:02 as the principal MHC association (odds ratio (OR) = 157.5, 95% CI 91.6-272.6, P = 6.6 × 10(-74)). We also identified two novel susceptibility loci at 5q15 near ERAP2 (rs7705093; OR = 2.3, 95% CI 1.7-3.1, for the T allele, P = 8.6 × 10(-8)) and at 14q32.31 in the TECPR2 gene (rs150571175; OR = 6.1, 95% CI 3.2-11.7, for the A allele, P = 3.2 × 10(-8)). The association near ERAP2 was confirmed in an independent British case-control samples (combined meta-analysis P = 1.7 × 10(-9)). Functional analyses revealed that the risk allele of the polymorphism near ERAP2 is strongly associated with high mRNA and protein expression of ERAP2 in B cells. This study further defined an extremely strong MHC risk component in BSCR, and detected evidence for a novel disease mechanism that affects peptide processing in the endoplasmic reticulum.

In two experiments with weaned piglets, the effects of fermented liquid feed (FLF) (produced with probiotic strain Pediococcus acidilactici, Bactocell®, Lallemand S.A.S.) on performance and some bacteriological and morpho-histological parameters of the gut were investigated, and the impact of sedimentation of the solids in the FLF thereon. In experiment I, FLF or the same dry feed (DRY) was offered ad libitum for 28 days to two groups of 15 weaned piglets (28 days of age) each (3 replicates of 5 pigs). Performance was negatively affected by feeding FLF and concomitant with that the group fed the FLF diet showed shorter villi (501 vs 550 µm) and smaller crypts (264 vs 289 µm) in the small intestine at 3 m proximal to the caecum (P < 0.05). It was assumed that these poorer results were due to sedimentation of the solids in the FLF and therefore a second experiment was conducted with sepiolite (10 g/kg) added to the feeds. Sepiolite tends to slow down the segregation of particles in slurry. The three feeding groups (weaned piglets, 27 days of age) in this experiment were DRY, DRY with probiotic (DRY+), and FLF. The group fed FLF (body weight gain (BWG) 254 g/piglet/day; feed : gain ratio 1.38) did now perform better (P < 0.05) than the groups fed the DRY (BWG 184 g/piglet/day; feed : gain ratio 1.52) and DRY+ (BWG 185 g/piglet/day; feed : gain ratio 1.48) diets, which did not differ. Villus length in the small intestine at 3 m proximal to the caecum was also higher for the group fed FLF (558 µm) compared with the group fed the DRY+ diet (490 µm; P < 0.05). It was concluded that feeding FLF is beneficial to freshly weaned piglets on condition that sedimentation of the solids in the feed slurry can be controlled.

This study aimed to investigate the effects and possible interactions of birth weight and n-3 polyunsaturated fatty acid (PUFA) supplementation of the maternal diet on the fatty acid status of different tissues of newborn piglets. These effects are of interest as both parameters have been associated with pre-weaning mortality. Sows were fed a palm oil diet or a diet containing 1% linseed, echium or fish oil from day 73 of gestation. As fish oil becomes a scarce resource, linseed and echium oil were supplemented as sustainable alternatives, adding precursor fatty acids for DHA to the diet. At birth, the lightest and heaviest male piglet per litter were killed and samples from liver, brain and muscle were taken for fatty acid analysis. Piglets that died pre-weaning had lower birth weights than piglets surviving lactation (1.27±0.04 v. 1.55±0.02 kg; P

Adolescent identity and parent-adolescent conflict have each attracted considerable research interest. However, few studies have examined the important link between the two constructs. The present study examined the associations between adolescent identity processing styles and adolescent conflict resolution styles in the mother-adolescent dyad. Questionnaires about conflict frequency and resolution were completed by 796 adolescents (66% female, mostly Caucasian) and their mothers. Adolescents also completed a measure on identity styles. Each identity style was hypothesized to relate to a specific conflict resolution behavior. Hierarchical regression analyses showed that the information-oriented identity style was positively associated with positive problem solving and negatively with conflict engagement and withdrawal, the normative style was positively associated with compliance, and, finally, the diffuse-avoidant style was positively associated with withdrawal and conflict engagement and negatively with positive problem solving. Our results demonstrated that the way in which adolescents tackle identity-relevant issues is related to the way in which they deal with conflicts with their mothers. Implications and suggestions for future research are discussed.

The objective was to determine the interest and psychometric properties of a new QOL self-assessment questionnaire suitable for children 8-12 years old measuring alpha, beta and gamma changes: the "Inventaire Systemique de Qualite de vie pour Enfants" (ISQV-E[C]). This was a cross-sectional validation study. 288 children have completed the ISQV-E. Other tools were used: The "Autoquestionnaire de Qualite de Vie Enfants Image" (AUQUEI), the State-Trait Anxiety Inventory for Children (STAIC), the Children's Depression Inventory (CDI). The internal consistency of the four scores of the ISQV-E (state, goal, rank and gap) is satisfactory. All scores have their own specificity. The data show the convergent validity, sensitivity and applicability of the ISQV-E. On the other hand, no satisfactory factorial structure was found although a multidimensional theoretical perspective was applied. The feasibility of the ISQV-E seems clearly demonstrated and the value of this new tool seems evident in contexts of physical, psychological or social problems. The validation study was promising but certain points such as test-retest reliability remain to be studied.

Thymol's antimicrobial properties urged researchers to study its effect on animal performance and intestinal health in pigs. However, thymol has the characteristic sharp odor of thyme and a bitter, aromatic, and sometimes burning sensation which may elicit feeding aversions. The objectives in the current study were: (1) to determine the effect of dose of thymol and camphor on palatability and (2) to test the hypothesis that supplemental flavours or camphor, the latter as a known Transient Receptor Potential A1 blocker, could mitigate feed avoidance caused by thymol. Two analogous choice-feeding trials were conducted. Feed intake of the test diet was expressed as proportion of the total intake and tested by means of a one-sample Student's t-test against a set value of 50%. The preference for feed supplemented with 125, 500, 1250 and 2000 mg/kg thymol was 53.7 ± 6.0% (P > 0.05), 47.5 ± 5.1% (P > 0.05), 36.8 ± 4.9% (P = 0.022), and 3.9 ± 7.9% (P = 0.005) respectively. When feed containing 2000 mg/kg thymol with either flavour A (containing intense sweeteners) or flavour B (containing the same intense sweeteners and a caramel aroma) was opposed against a control diet, the relative intake of the test diets was 19.9 ± 5.8% and 14.0 ± 4.9% (both P < 0.05) respectively. When animals were offered one of these test diets and a reference diet with 2000 mg/kg thymol, animals exhibited a preference for the feed with 2000 mg/kg thymol + flavour A, but not for the feed with 2000 mg/kg thymol + flavour B. Thus, supplemental flavours containing intense sweeteners partially overcame feed avoidance caused by thymol which was less pronounced when the caramel aroma was present. Exposure to camphor (50 and 200 mg/kg) did not improve feed preference for a diet containing 1250 mg/kg thymol. Thymol's bitter taste might be largely responsible for the recorded feed refusal at high inclusion rates.

The present study investigated whether enrichment of the pig maternal diet with n-3 polyunsaturated fatty acids (PUFA) affects the fatty-acid composition of female piglets via enhancing of expression of the lipogenic enzymes Δ5-desaturase (Δ5d) and Δ6-desaturase (Δ6d). The sows (50% Landrace × 50% Large White) were fed a control diet or one of the experimental diets starting at day 45 in gestation. The experimental diets were supplemented either with linseed oil or fish oil, whereas the control diet contained palm oil. Expression of Δ5d and Δ6d, and fatty-acid composition was determined by Western blotting and gas-liquid chromatography, respectively, in muscle, subcutaneous adipose tissue and liver. The highest Δ5d protein expression was observed in the piglets’ muscle, followed by subcutaneous adipose tissue, with the lowest level in the liver. Expression of Δ6d in the piglets’ tissues followed an opposite pattern, and was highest in the liver, followed by subcutaneous adipose tissue, with the lowest level in muscle. Supplementation of the maternal diet with fish oil or linseed oil increased the level of n-3 PUFA of the piglets in a tissue-specific manner. The response of Δ6d and Δ5d protein expression in female piglets, with average birth weight 2.4 kg, to the dietary manipulation was also tissue-specific. It is suggested that the increase in n-3 PUFA content in the progeny was related, at least partially, to the activation of Δ6d and Δ5d expression.