Recovery at an Adult Psychiatric Day Hospital-A Qualitative Interview Study Describing Patients' Experiences.

Psychiatric Day Hospitals offer time-limited active treatment programmes that are therapeutically intensive, coordinated, and with structured clinical services within a stable environment. No previous studies have described patients' experiences of recovery-oriented care at a Psychiatric Day Hospital in a Swedish or Nordic healthcare context. The aim of the study was to explore patients' experiences of a Psychiatric Day Hospital with focus on patient recovery. A qualitative method was used; 12 in-depth interviews were performed with patients all analysed with content analysis. The theme that emerged was "A safe haven." To do something routinely and meaningful during the days, feelings of security, and to gain increased knowledge about mental ill health were concepts which felt important and contributed to recovery. Feelings of belonging and prevention of loneliness were also highlighted.

The Core Elements of Psychiatric and Mental Health Nursing: Time, Honest Engagement, Therapeutic Relations, Professional Nursing and Lifetime-Perspective.

Defining psychiatric and mental health nursing has been a challenge for decades, and it is still difficult to find a comprehensive definition. We have identified a possibility to clarify psychiatric and mental health nursing based on humanistic philosophy in a general psychiatric care context. The aim was therefore to identify and synthesize the theoretical frameworks from which psychiatric and mental health nursing models are developed. We systematically collected and evaluated articles based on Grounded Theory (GT) methodology regarding psychiatric or mental health nursing. The PRISMA statement for systematic reviews was used and the formal process of synthesis, as a three-step process of identifying first -, second - and third-order themes following the examples of Howell Major and Savin-Baden. The synthesis resulted in a model describing five core elements of psychiatric and mental health nursing: 'professional nursing', 'therapeutic relationships' and 'honest engagement', with time as the all-encompassing theme, including the patients' 'lifetime perspective'. Psychiatric and mental health nursing is a caring support towards recovery, where the patient's lifetime perspective must be in focus during the caring process with a relationship built on an honest engagement. Time is therefore essential for psychiatric and mental health nursing.

Nurses' Perceptions of Telephone Triage in Child and Adolescent Psychiatric Services - An Enhanced Critical Incident Technique Study.

In Sweden, units managed by nurses specialised in counselling and telephone triage, have been developed within the Child and Adolescent Mental Health services (CAMHS). This study has a qualitative design and illuminates the nurses' perceptions of what helps or hinders their assessments and telephone triage. The Enhanced Critical Incident Technique was utilised, eight nurses were interviewed in depth, to identify factors influencing triage. The study is the first to provide a comprehensive description of helpful and hindering factors while performing telephone triage. It illuminates telephone triage in Swedish CAMHS settings and provides insights how to enhance and implement this practice.

The Hairdex quality of life instrument-A translation and psychometric validation in patients with alopecia areata.

Background: The German Hairdex quality of life (QoL) instrument is specific to hair and scalp diseases, developed for self-rating and consists of 48 statements divided into five domains: Symptoms, Functioning, Emotions, Self-confidence and Stigmatisation. There was a need of a Swedish reliability tested, validated hair and scalp specific QoL instrument why the German Hairdex was chosen to be translated and reliability tested in a systematic way. Objectives: To make a translation, a reliability test of stability, and validation of the German Hairdex QoL instrument among 100 Swedish patients with a dermatological ICD-10 diagnosis of alopecia areata (AA). Methods: An eight-step method by Gudmundsson was used as a model with a forward and backward translation and with comments from an expert panel. A statistical test-retest (ICC (2,1)) analysis was made, followed by an internal consistency analysis. A comparison between the German and Swedish Hairdex-S constructs by a principal component analysis was performed. Results: The Hairdex-S was very well accepted by patients. The ICC(2,1) test-retest showed a good to excellent correlation of 0.91 (CI [0.85-0.95]). Internal consistency was α = 0.92. Like the original Hairdex, Hairdex-S showed good factorability with a Kaiser-Meyer-Olkin measure of 0.82 and with one component explaining 70% of the variance: original Hairdex instrument (69%). When tested on patients with AA, the domains Functioning and Emotions had the strongest loadings, followed by Stigmatisation and Self-confidence. Younger AA patients at self-assessment and patients who reported to be younger at the onset of AA, scored statistically significantly higher on the Hairdex-S, indicating an overall lower QoL on domains Emotions and Functioning, respectively. Conclusions: The Hairdex-S is very well accepted by AA patients, shows very good psychometric properties, and a very good agreement with the original Hairdex. The Swedish Hairdex instrument can be recommended for evaluation of patients QoL as well as for research purposes.

Self-Reported Experience of Abuse During the Life Course Among Men Seeking General Psychiatric or Addiction Care-A Prevalence Study in a Swedish Context.

A prevalence study was conducted using the NorVold Abuse Questionnaire for men (m-NorAQ) to estimate the prevalence of self-reported experience of life-course abuse and to identify the perpetrators of the abuse. This among men seeking general psychiatric and addiction care in a Swedish context. In total, 210 men completed the questionnaire, and were included in the study. The total prevalence of life-course abuse (i.e., any emotional, physical or sexual abuse during the life course) was 75% (n = 157). The results of this study indicate the importance of identifying experiences of life-course abuse among men in general psychiatric and addiction care settings.

The psychiatric mental health nurse's ethical considerations regarding the use of coercive measures - a qualitative interview study.

BACKGROUND: In psychiatric inpatient care, situations arise where it may be necessary to use coercive measures and thereby restrict individual autonomy. The ethical principles of healthcare, i.e., respect for autonomy, beneficence, nonmaleficence, and justice, are recognized as central aspects in healthcare practice, and nurses must be clear about which ethical theories and principles to prioritize and what values are needed for a thorough ethical consideration. The aim of this study is to shed light on psychiatric mental health nurses' ethical considerations and on the factors influencing them when performing coercive measures. METHODS: This qualitative interview study included twelve psychiatric mental health nurses with experience from psychiatric inpatient care. A content analysis was made. The interviews were audio recorded and transcribed verbatim, and categories were formulated. RESULTS: The study revealed a duality that created two categories: Ethical considerations that promote the patient's autonomy and health and Obstacles to ethical considerations. Based on this duality, ethical considerations were made when performing coercive measures to alleviate suffering and promote health. The result shows a high level of ethical awareness in clinical work. However, a request emerged for more theoretical knowledge about ethical concepts that could be implemented among the staff. CONCLUSION: The psychiatric mental health nurses in this study strive to do what is best for the patient, to respect the patient's autonomy as a guiding principle in all ethical considerations, and to avoid coercive measures. An organizational ethical awareness could increase the understanding of the difficult ethical considerations that nurses face with regard to minimizing the use of coercive measures in the long run.

A review of adverse events in animals and children after secondary exposure to transdermal hormone-containing medicinal products.

Background: Hormonal replacement therapy is widely used to treat conditions in humans, the most well-known indication being the relief of menopausal symptoms in women. Many of the hormone-containing products (HCP) are applied to the skin. This transdermal delivery poses a risk to animals and humans through secondary exposure, especially when product information is not strictly followed. The aim of this article is to raise awareness among veterinarians and human healthcare providers of this risk; based on evidence from spontaneous reporting of suspected adverse events (AEs) in animals and humans. Interventions are also explored to mitigate the risk of secondary exposure to transdermal HCP (THCP). Review of spontaneously reported suspected AEs: The Swedish Medical Products Agency has received several, mainly serious, AE reports in animals and children following secondary exposure to THCPs. The AE reports were reviewed together with worldwide data from the EudraVigilance Veterinary database and human EudraVigilance Data Analysis System. The clinical signs reported in animals included persistent signs of oestrus, poor growth rate and birth defects. In humans, reported clinical signs included precocious puberty, unresolved virilisation, accelerated growth rate and female infertility. Conclusions: It is important that THCP are used according to manufacturer's instructions and users are made aware of risks and mitigating measures. This review of AEs in animals and children provides evidence to show that the use of THCP poses a risk for secondary exposure. Efficient communication strategies that stretch across veterinary and human medicinal disciplines are required to raise mutual awareness and minimise the risk of AEs in animals and humans.

Dissemination of Resistant Escherichia coli Among Wild Birds, Rodents, Flies, and Calves on Dairy Farms.

Antimicrobial resistance (AMR) in bacteria in the livestock is a growing problem, partly due to inappropriate use of antimicrobial drugs. Antimicrobial use (AMU) occurs in Swedish dairy farming but is restricted to the treatment of sick animals based on prescription by a veterinary practitioner. Despite these strict rules, calves shedding antimicrobial resistant Enterobacteriaceae have been recorded both in dairy farms and in slaughterhouses. Yet, not much is known how these bacteria disseminate into the local environment around dairy farms. In this study, we collected samples from four animal sources (fecal samples from calves, birds and rodents, and whole flies) and two environmental sources (cow manure drains and manure pits). From the samples, Escherichia coli was isolated and antimicrobial susceptibility testing performed. A subset of isolates was whole genome sequenced to evaluate relatedness between sources and genomic determinants such as antimicrobial resistance genes (ARGs) and the presence of plasmids were assessed. We detected both ARGs, mobile genetic elements and low rates of AMR. In particular, we observed four potential instances of bacterial clonal sharing in two different animal sources. This demonstrates resistant E. coli dissemination potential within the dairy farm, between calves and scavenger animals (rodents and flies). AMR dissemination and the zoonotic AMR risk is generally low in countries with low and restricted AMU. However, we show that interspecies dissemination does occur, and in countries that have little to no AMU restrictions this risk could be under-estimated.

Nurses' leadership in psychiatric care-A qualitative interview study of nurses' experience of leadership in an adult psychiatric inpatient care setting.

WHAT IS KNOWN ON THE SUBJECT?: Previous studies on leadership in psychiatric care have focussed on a diversity of staff and on different healthcare settings. Nurses in both Sweden and internationally, working with patients newly diagnosed with psychosis and addiction, describe an overwhelming workload. Existing research points out that experience and leadership training are the most important factors to exert a good nursing leadership. In Sweden, requirements for leadership exists already from the first day of a nurse's career. The relationship and communication between nurses in psychiatric care and members of the staff is decisive for whether the leadership will work. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: The study adds knowledge regarding the challenges leading the nursing care for patients diagnosed with psychosis and addiction. Ambivalence in the leadership role is prominent among nurses in psychiatric care and feelings of responsibility and meaningfulness are mixed with feelings of powerlessness and uncertainty. Swedish psychiatric nurses lack mandate to lead psychiatric nursing care. This may increase the feelings of uncertainty in their leadership role. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A mandate to lead as well as a leadership guidance in communication and teambuilding will enhance the leadership, especially among newly graduated nurses. Heightened awareness within the healthcare organization about nurse's experience of difficulties in leading the psychiatric nursing care of the most severe psychiatric illnesses could increase the right prerequisites for leadership. ABSTRACT: Introduction Research shows that psychiatric nursing care puts additional demands on the nurse as a leader due to the psychological complexity of care. Experience and leadership training are most important to exert leadership. In Sweden, demands for leadership exist already at the beginning of a nursing career, and in psychiatry, it may lead to an overwhelming workload. Aim/Question The aim of the present study is to highlight nurses' experiences of leading the psychiatric nursing care in an adult psychiatric context. Method A qualitative interview study of eleven registered nurses within psychiatric inpatient care. Content analysis was used for analysis. Results Leading with combined feelings of both meaningfulness and uncertainty were the theme arising from the result. Discussion Findings from Swedish and international studies stress special demands on leadership in psychiatric care. The result shows that nurses perceived an ambivalence of their leadership in terms of both meaningfulness and uncertainty. Implications for Practice An official mandate to lead as well as leadership guidance in communication and teambuilding will enhance leadership, especially among newly graduated nurses. Heightened awareness within healthcare organizations about difficulties in leading psychiatric nursing care could increase the possibility to create right prerequisites for leadership.

A survey of veterinary professionals in Sweden: Adverse event reporting and access to product safety information.

BACKGROUND: Pharmacovigilance based on spontaneously reported suspected adverse events (AEs) from veterinary professionals is a powerful tool for detecting potential risks of using medicinal products. However, it is heavily dependent on the voluntary participation of veterinary professionals. Estimates suggest that over 90% of suspected AEs remain unreported. This survey was conducted to accumulate information on current practices and attitudes of Swedish veterinary professionals in relation to AE reporting and their perceptions of the accessibility of updated product safety information. METHODS: Swedish veterinary professionals were surveyed using a web-based questionnaire prepared by the Swedish Medical Products Agency (SMPA). The survey included three sections with 13 questions and was distributed via several communication channels, including the Swedish Veterinary Association. RESULTS: The survey was answered by 412 veterinary professionals, including veterinarians and licensed veterinary nurses. The survey identified that most veterinarians comply with national legislation by reporting directly to the SMPA, but not all observed AEs are reported. Veterinary professionals indicated that it is important to have an easy and efficient reporting system, preferably directly from an electronic medical records system. Feedback is considered important. Veterinary nursing staff could potentially improve the reporting rate of suspected AEs in Sweden. The degree of knowledge relating to the reporting of AEs varies among professionals, thus impacting on reporting frequency. A single source of product safety information is mainly used, and improvements are required to enhance accessibility and distribution of updated product safety information. CONCLUSIONS: The insight gained from this survey will be used to influence attitudes and facilitate adaptations needed to fulfil the requirements of the European Union regulations. To reduce underreporting of AEs and facilitate access to updated product safety information, various approaches are required including educational interventions, new digital reporting tools and adaption of communication strategies.

Risk for mental illness and family composition after migration to Sweden.

OBJECTIVES: The aim of the present study is to determine how marital status and certain post-migration family structures are associated with the risk of mental illness among recently arrived Arabic- speaking refugees in Sweden. METHODS: A cross-sectional study was conducted during 2015 and 2016. The study population was recruited by inviting all adult refugees who participated in the mandatory public integration support programme. All refugees that participated had received refugee status. A total of 681 of the invited participants returned the GHQ-12 questionnaires, through which the risk for mental illness was measured and only Arabic- speaking refugees (N = 638) were included in the analyses. RESULTS: Marital status per se was not associated with a risk for mental illness. However, for the whole study sample there was a statistical significant odds ratio of 1.72 (95% CI 1.03-2.86). For male Arabic-speaking refugees with a spouse or child left behind in the home country there was a borderline significant increased risk for mental illness, odds ratio = 1. 87 (95% CI 0.99-3.56). The risk for female Arabic-speaking refugees was non-significant, odds ratio = 1.35 (95% CI 0.55-3.33). CONCLUSIONS: Arabic- speaking refugees who were separated from family members reported an increased risk for mental illness after arriving in the host country. Actions to facilitate family reunion after arriving as a refugee (in Sweden) seems to be an important factor to promote mental health among refugees.

Errors linked to medication management in nursing homes: an interview study.

BACKGROUND: The number of errors in medication management in nursing homes is increasing, which may lead to potentially life-threatening harm. Few studies on this subject are found in the municipal nursing home setting, and causes need to be identified. The aim of this study was to explore perceptions of errors connected to medication management in nursing homes by exploring the perspective of first-line registered nurses, registered nurses, and non-licensed staff involved in the care of older persons. METHODS: A qualitative research approach was applied based on semi-structured interviews with 21 participants at their workplaces: Seven in each of the occupational categories of first-line registered nurses, registered nurses, and non-licensed staff. Subcategories were derived from transcribed interviews by content analysis and categorized according to the Man, Technology, and Organization concept of error causation, which is as a framework to identify errors. RESULTS: Mistakes in medication management were commonly perceived as a result of human shortcomings and deficiencies in working conditions such as the lack of safe tools to facilitate and secure medication management. The delegation of drug administration to non-licensed staff, the abandonment of routines, carelessness, a lack of knowledge, inadequate verbal communication between colleagues, and a lack of understanding of the difficulties involved in handling the drugs were all considered as risk areas for errors. Organizational hazards were related to the ability to control the delegation, the standard of education, and safety awareness among staff members. Safety issues relating to technology involved devices for handling prescription cards and when staff were not included in the development process of new technological aids. A lack of staff and the lack of time to act safely in the care of the elderly were also perceived as safety hazards, particularly with the non-licensed staff working in nursing homes. CONCLUSIONS: The staff working in nursing homes perceive that the risks due to medication management are mainly caused by human limitations or technical deficiencies. Organizational factors, such as working conditions, can often facilitate the occurrence of malpractice. To minimize mistakes, care managers need to have a systemwide perspective on safety issues, where organizational issues are essential.

Antibiotic Use in Organic and Non-organic Swedish Dairy Farms: A Comparison of Three Recording Methods.

Biases of antimicrobial use (AMU) reporting systems pose a challenge to monitoring of AMU. Our study aimed to cross-compare three data sources of AMU in Swedish dairy herds to provide an account of the validity of AMU reports. We studied AMU differences between two production systems, to investigate how the reporting system affected this comparison. On-farm quantification of AMU via a manual collection of empty drug containers (BIN) took place in organic (n = 30) and conventional (n = 30) dairy herds during two periods between February 2016 and March 2017. A data extract mirroring these periods was obtained from two linked datasets that contain AMU data as reported by the prescribing veterinarians. These included data from the Swedish Board of Agriculture system (SBA) and Växa milk recording system (VXA). Using the European Medicines Agency technical units, the total number of defined daily doses (DDDvet), and defined course doses (DCDvet) per animal/year were calculated for each herd/period/dataset. Descriptive statistics and Bland-Altman plots were used to evaluate the agreement and systematic bias between the datasets. Mixed models for repeated measures were used to assess AMU differences between production systems. We found consistent numerical differences for the calculated AMU metrics, with BIN presenting higher usage compared to the SBA and VXA. This was driven by a disparity in intramammary tubes (IMt) which appear to be underreported in the national datasets. A statistically significant interaction (BIN dataset) between the production system and drug administration form was found, where AMU for injectable and lactating cow IMt drug forms differed by the production system, but no difference was found for dry-cow IMt. We conclude that calculating AMU using DDDvet and DCDvet metrics at a herd level based on Swedish national datasets is useful, with the caveat of IMt potentially being misrepresented. The BIN method offers an alternative to monitoring AMU, but scaling up requires considerations. The lower disease caseload in organic herds partly explains the lower AMU in particular drug forms. The fact that organic and conventional herds' had equally low AMU for dry-cow IMt, coupled with mismatches in IMt report across herds indicated an area of further research.

Antimicrobial Resistance Patterns in Organic and Conventional Dairy Herds in Sweden.

Monitoring antimicrobial resistance (AMR) and use (AMU) is important for control. We used Escherichia coli from healthy young calves as an indicator to evaluate whether AMR patterns differ between Swedish organic and conventional dairy herds and whether the patterns could be related to AMU data. Samples were taken twice, in 30 organic and 30 conventional dairy herds. Selective culturing for Escherichia coli, without antibiotics and with nalidixic acid or tetracycline, was used to estimate the proportions of resistant isolates. Microdilution was used to determine the minimum inhibitory concentrations (MICs) for thirteen antimicrobial substances. AMU data were based on collection of empty drug packages. Less than 8% of the bacterial growth on non-selective plates was also found on selective plates with tetracycline, and 1% on plates with nalidixic acid. Despite some MIC variations, resistance patterns were largely similar in both periods, and between organic and conventional herds. For most substances, only a few isolates were classified as resistant. The most common resistances were against ampicillin, streptomycin, sulfamethoxazole, and tetracycline. No clear association with AMU could be found. The lack of difference between organic and conventional herds is likely due to a generally good animal health status and consequent low AMU in both categories.

Cross-border spread of blaNDM-1- and blaOXA-48-positive Klebsiella pneumoniae: a European collaborative analysis of whole genome sequencing and epidemiological data, 2014 to 2019.

Analysis of sequencing data for 143 blaNDM-1- and blaOXA-48-positive Klebsiella pneumoniae isolates from 13 European national collections and the public domain resulted in the identification of 15 previously undetected multi-country transmission clusters. For 10 clusters, cases had prior travel/hospitalisation history in countries outside of the European Union including Egypt, Iran, Morocco, Russia, Serbia, Tunisia and Turkey. These findings highlight the benefit of European whole genome sequencing-based surveillance and data sharing for control of antimicrobial resistance.

Subjective and Objective Characteristics of Patients Seen at a Psychodermatology Unit: One-year Experience in Malmö, Sweden.

Clinical epidemiological knowledge concerning psychodermatology patients is scarce. The objective of this study was to assess morbidity in a new psychodermatology service. Information was gathered from patient records at the psychodermatology unit in Skåne University Hospital, Malmö, Sweden, from 1 February 2017 to 31 January 2018. All patients were screened with the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI) at baseline and after 12 months. Additional information was collated from the patient records. A total of 50 patients were treated during the 12 months, 86% were women, mean age 44 years (standard deviation (SD) 16 years). Itch was present in 72% of patients. Forty-two percent of patients were diagnosed with mood disorders, 30% with personality disorders, and 16% with delusional disorders. At baseline 40% of patients had a DLQI score >11, clinical depression was present in 14%, and clinical anxiety in 28%. These data emphasize the need for access to a multidisciplinary unit for dermatology patients.

Depressive symptoms during pregnancy and postpartum in women and use of antidepressant treatment - a longitudinal cohort study.

OBJECTIVE: The aim of this study was to investigate whether women, who reported "symptoms of depression" during pregnancy and up to 1.5 years postpartum, who reported domestic violence or not, were treated with antidepressant medication. PATIENTS AND METHODS: A prospective longitudinal cohort study recruited primi- and multiparous women (n=1,939). The Edinburgh Postnatal Depression Scale (EPDS), the NorVold Abuse Questionnaire, and a questionnaire about medication during pregnancy were distributed and administered three times, during early pregnancy, late pregnancy, and the postpartum period. Antidepressant medication was compared between women with EPDS scores <13 and EPDS scores ≥13 as the optimal cutoff for symptoms of depression. RESULTS: EPDS scores ≥13 were detected in 10.1% of the women during the whole pregnancy, of those 6.2% had depressive symptoms already in early pregnancy and 10.0 % during the postpartum period. Women with EPDS scores ≥13 and non-exposure to domestic violence were more often non-medicated (P<0.001). None of the women with EPDS scores ≥13 exposed to domestic violence had received any antidepressant medication, albeit the relationship was statistically nonsignificant. CONCLUSION: Pregnant women who experienced themselves as having several depressive symptoms, social vulnerability, and even a history of domestic violence, did not receive any antidepressant treatment during pregnancy nor postpartum. This study shows the importance of detecting depressive symptoms during early pregnancy and a need for standardized screening methods.

Dairy farmers' perspectives on antibiotic use: A qualitative study.

An important step in limiting the development of antibiotic resistance is reducing use of antibiotics in animal husbandry. Much research in this area has focused on individual farmer behavior, aiming to better align actual use with medical recommendations. However, farmers' practices and reasoning around their antibiotic use do not reflect solely that farmer as an individual. Rather, practices and worldviews are guided by context (e.g., veterinary advice, peer pressure, regulation, and interactions with farm animals). Studies that jointly embrace farmer agency and the wider structures for this agency, however, remain scarce. This paper draws on theories of behavior as socially constructed, and in particular on the concept of the "good farmer," to interpret findings from a study of 7 Swedish dairy farms. The results show that all farmers have close daily contact with their animals, have strong emotional ties, and place emphasis on the importance of being able to judge animal health status by eye. Half of the farms use an automatic milking system, and for these farmers automation means better monitoring of animal health without losing contact with the cows. The local veterinarian is considered a positive and important authority whose advice is valued. Despite comparatively strict antibiotic use regulations in Sweden, the farmers do not report lack of access to antibiotics when needed. However, they report feeling disadvantaged in international trade and poorly treated by the Swedish government, which allows imports of cheaper meat and dairy products produced under less strict regulations. The farmers are well informed about how to prevent and treat common diseases. In cases where they do not follow recommendations, we found that economic and labor constraints are the reason rather than lack of knowledge. We concluded that structural limitations faced by farmers, rather than lack of information, impose constraints to further limiting antibiotic use in Sweden. Overall stricter and more uniform global regulations on antibiotic use in animal farming could be an effective measure for reducing antibiotic use.

Escherichia coli Sequence Type 410 Is Causing New International High-Risk Clones.

Escherichia coli sequence type 410 (ST410) has been reported worldwide as an extraintestinal pathogen associated with resistance to fluoroquinolones, third-generation cephalosporins, and carbapenems. In the present study, we investigated national epidemiology of ST410 E. coli isolates from Danish patients. Furthermore, E. coli ST410 was investigated in a global context to provide further insight into the acquisition of the carbapenemase genes blaOXA-181 and blaNDM-5 of this successful lineage. From 127 whole-genome-sequenced isolates, we reconstructed an evolutionary framework of E. coli ST410 which portrays the antimicrobial-resistant clades B2/H24R, B3/H24Rx, and B4/H24RxC. The B2/H24R and B3/H24Rx clades emerged around 1987, concurrently with the C1/H30R and C2/H30Rx clades in E. coli ST131. B3/H24Rx appears to have evolved by the acquisition of the extended-spectrum ß-lactamase (ESBL)-encoding gene blaCTX-M-15 and an IncFII plasmid, encoding IncFIA and IncFIB. Around 2003, the carbapenem-resistant clade B4/H24RxC emerged when ST410 acquired an IncX3 plasmid carrying a blaOXA-181 carbapenemase gene. Around 2014, the clade B4/H24RxC acquired a second carbapenemase gene, blaNDM-5, on a conserved IncFII plasmid. From an epidemiological investigation of 49 E. coli ST410 isolates from Danish patients, we identified five possible regional outbreaks, of which one outbreak involved nine patients with blaOXA-181- and blaNDM-5-carrying B4/H24RxC isolates. The accumulated multidrug resistance in E. coli ST410 over the past two decades, together with its proven potential of transmission between patients, poses a high risk in clinical settings, and thus, E. coli ST410 should be considered a lineage with emerging "high-risk" clones, which should be monitored closely in the future.IMPORTANCE Extraintestinal pathogenic Escherichia coli (ExPEC) is the main cause of urinary tract infections and septicemia. Significant attention has been given to the ExPEC sequence type ST131, which has been categorized as a "high-risk" clone. High-risk clones are globally distributed clones associated with various antimicrobial resistance determinants, ease of transmission, persistence in hosts, and effective transmission between hosts. The high-risk clones have enhanced pathogenicity and cause severe and/or recurrent infections. We show that clones of the E. coli ST410 lineage persist and/or cause recurrent infections in humans, including bloodstream infections. We found evidence of ST410 being a highly resistant globally distributed lineage, capable of patient-to-patient transmission causing hospital outbreaks. Our analysis suggests that the ST410 lineage should be classified with the potential to cause new high-risk clones. Thus, with the clonal expansion over the past decades and increased antimicrobial resistance to last-resort treatment options, ST410 needs to be monitored prospectively.

Biosecurity and animal disease management in organic and conventional Swedish dairy herds: a questionnaire study.

BACKGROUND: Good animal health is a notion that is germane to organic dairy production, and it is expected that such herds would pay significant attention on the health of their animals. However, it is not known if the applied animal disease management is actually more adequate in organic dairy cattle herds than in conventional dairy herds. A questionnaire study on biosecurity and animal disease management activities was therefore conducted among Swedish farmers with organic and conventional dairy cattle herds. RESULTS: A total of 192 useable questionnaires were returned; response rates of 30.3 and 20.2% for organic and conventional farmers, respectively. Herd characteristics of the two herd types were very similar, except that pipeline/tie-stall systems were less common in organic farms and that organic farmers had a higher education level than their conventional counterparts. Also, very few systematic differences in general or specific disease management activities were observed between the two types of farms. The main exceptions being how milk from cows during antibiotic treatment was used, views on policy actions in relation to antibiotic use, and attitudes towards calling for veterinary support. Using milk from cows during antibiotic treatment was more common in conventional herds, although it was mainly given to bull calves. Farmers of organic herds were more positive to policy actions to reduce the use and need for antibiotics, and they reported waiting longer before contacting a veterinarian for calves with diarrhoea and cows with subclinical mastitis. CONCLUSIONS: The stated biosecurity and animal disease management was relatively equal in Swedish organic and conventional dairy herds. Our results thus indicate that animal health is as important in conventionally managed dairy herds in Sweden as in organically managed herds.