[Informal care for dementia according to type of service]. / Informelle Pflege bei Demenz nach Leistungsarten.

BACKGROUND: Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not by its components. OBJECTIVE: We aimed to assess the degree of association between specific informal care services and dementia. MATERIAL AND METHODS: This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating and eight individual informal care services were considered. Logistic regression models were used to assess associations. RESULTS: Of the 864 participants 18% suffered from dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on "supervision", "regulation of financial matters" and "assistance in the intake of medication". Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia. CONCLUSION: The provision of all types of informal care services is associated with dementia. The association is pronounced for services that can be more easily integrated into the daily routines of the informal caregiver. Policy makers who plan to integrate informal care into the general care arrangements for dementia should consider this.

Discrimination of isolates of Mycobacterium bovis in Northern Ireland on the basis of variable numbers of tandem repeats (VNTRs).

The ability to reproducibly discriminate Mycobacterium bovis isolates and trace their transmission has the potential to clarify sources of infection and major routes of transmission for bovine tuberculosis (TB). A PCR-based genotyping assay has been developed to discriminate between strains of M bovis by examining multiple sites in its genome that consist of variable numbers of tandem repeats (VNTRS). The discriminatory power and reproducibility of this VNTR typing has been compared with that of the established PCR-based spoligotyping technique by using a panel of 461 isolates of M bovis prevalent in Northern Ireland. The VNTR assay discriminated 40 different profiles, the most prevalent of which constituted 21 per cent of the total, compared with 14 profiles discriminated by spoligotyping, the most prevalent of which constituted 65 per cent. No significant differences were observed between the prevalences of the VNTR profiles in the years from 1999 to 2003. A preliminary evaluation indicated that most genotypes predominated in particular areas of the country. This VTNR typing assay was found to be highly discriminating, with the performance characteristics to support its systematic application to the molecular epidemiology of bovine TB.

A comparison of early and mid grazing season suppressive anthelmintic treatments for first year grazing calves and their effects on natural and experimental infection during the second year.

A comparison was made of the efficacy and parasitological sequelae over 2 years, of continuous and intermittent periods of anthelmintic suppression applied both early and in the middle of the first grazing season of calves. Five groups of 15 calves grazing separate paddocks within the same field were allotted to one of the following treatment regimes during their first year at grass: Group 1, untreated controls; Group 2, treated with ivermectin injections at 3, 8 and 13 weeks after turnout; Group 3, treated with ivermectin injections at 10, 15 and 20 weeks after turnout; Group 4, treated with a morantel slow release intraruminal bolus at turnout; Group 5, treated with a morantel slow release bolus at 10 weeks after turnout. Five animals from each group were slaughtered at the end of both grazing seasons. Two months after the end of the second season the remaining five calves were challenged with an experimental infection of 250,000 third-stage larvae (L3) of both Ostertagia ostertagi and Cooperia oncophora. All treatment regimes protected the respective calves from parasitic gastroenteritis. Over the 2 year observation period Groups 2 and 4 showed significantly better weight gain than other groups, and at the end of the first season, they were found to harbour significantly fewer O. ostertagi in the early fourth stage of development. During Year 1, Groups 2 and 3 excreted much lower percentages of Ostertagia spp. eggs than other groups. In Year 2, Group 2 excreted a higher percentage of Ostertagia spp. eggs although the total egg output was approximately half that of Group 1 during the same period. The results showed that the effects of anthelmintic suppression on egg output of different nematode species was affected by the activity of the anthelmintic used.

The immunization of cattle against Babesia divergens with fractions of parasitized erythrocytes.

A lysate of erythrocytes infected with Babesia divergens was subjected to isoelectric focusing within a pH range of 3.5-9.5. The focused proteins were split into 2 fractions depending on pH (1) those from 3.5-6.5 and (2) those from 6.5-9.5. The acidic fraction was used as an immunogen for groups of 5 adult cows using 2 different adjuvants, saponin and a mixture of muramyldipeptide (MDP) and incomplete Freund's adjuvant (IFA). Two other groups of 5 cows were simultaneously treated with the alkaline fraction and a sample of the complete lysate with the MDP/IFA adjuvant. The treated cows plus a control group were infected with 2.5 X 10(8) erythrocytes infected with a homologous strain of B. divergens. When compared with the controls all pre-treated groups were protected to some degree. There were significant differences between the treated groups with the group which received MDP/IFA combined with the acidic fraction showing most resistance to the infection. The experiment also showed that the MDP/IFA adjuvant produced more protection than the saponin.

Induction of protective immunity to Dictyocaulus viviparus in calves while under treatment with endectocides.

Three groups of five parasite-naive calves were used. The treatments were: (a) Group 1 calves were weighed on Day 0 and injected with doramectin at 200 microg/kg. From Day 1 to 19 they were dosed orally with 2000 infective larvae of Dictyocaulus viviparus. On Day 28 they were again injected with doramectin, and infected with D. viviparus larvae from Days 33 to 41. They were then left untreated until Day 81 when they were infected with 20 infective larvae of D. viviparus per kg body weight. They were killed on Day 110 and lungworms were counted; (b) Group 2 calves were immunised with oral lungworm vaccine on Days 0 and 28, and infected and slaughtered as Group 1 on Days 81 and 110, respectively; (c) Group 3 calves acted as infection controls. Blood samples were taken at Days 0, 21, 49, 77 and 110 for antibody tests to D. viviparus. At autopsy there were no significant differences between the number of lungworms from Groups 1 and 2 (Means 17.4 and 31.3, respectively); Group 1 had significantly less value than Group 3 (Mean 228) (p < 0.05). Increased antibody titres to the larval sheath of the infective larvae were observed from Groups 1 and 2, showing that the larvae in Group 1 had penetrated the intestine before being killed by the circulating anthelmintic. This experiment shows that if calves are exposed to infective larvae while under systemic endectocide cover, an immune reaction is stimulated.

The effect of route of administration of a Babesia divergens inactivated vaccine on protection against homologous challenge.

Two groups of 5 adult cows were immunized with a concentrated lysate of blood from a splenectomized calf infected with Babesia divergens with a parasitaemia of 20 per cent. The lysate was administered in 2 doses with a 14-day interval between them; it was injected subcutaneously to one group and intravenously to the other. Nineteen days after the second inoculation, both groups plus a third group of similar cows which acted as controls were infected subcutaneously with blood containing 10(9) B. divergens of the same strain, and clinical and haematological variables were monitored closely for 3 weeks. Both pretreated groups were much less seriously affected than the controls, with the group inoculated subcutaneously showing the least effects due to the challenge infection. It was concluded that protection could be induced against infections of B. divergens by injection of inactivated parasites of the same strain, and that subcutaneous inoculation was preferable to intravenous.

Comparison of early season suppressive anthelmintic prophylactic methods for parasitic gastroenteritis and bronchitis in calves.

A comparison was made of the material costs and effectiveness of three methods of early season suppression by anthelmintic medication of Ostertagia species and two of Dictyocaulus viviparus in calves, each method suppressing faecal egg output for different lengths of time from the start of spring grazing. The anthelmintics used were: Morantel bolus administered five days before going to grazing; oxfendazole given three times at three, six and nine weeks after the start of grazing and ivermectin injected three, eight and 13 weeks after going to pasture. The effectiveness of each was estimated by comparison with worm numbers in untreated control calves. Oxfendazole, which was active for the shortest time (about 65 days) from the start of grazing (May 1), produced a 78.1 per cent reduction in Ostertagia species and an 84.4 per cent reduction in D viviparus. The morantel bolus was estimated to be active for 90 days and resulted in a 94.3 per cent reduction of Ostertagia species. The ivermectin treatment, which, because of the prolonged excretion of the chemical and different sensitivity of worm species, was estimated to suppress Ostertagia species for 105 days and D viviparus for 119 days, caused reductions of 98.7 per cent of the former and 97.4 per cent of the latter species. Material costs per calf were estimated at pounds 1.25 for oxfendazole, pounds 2.00 for ivermectin and pounds 10 for the morantel bolus.

Efficacy of a homoeopathic prophylaxis against experimental infection of calves by the bovine lungworm Dictyocaulus viviparus.

Two groups of parasite-free calves, one of which had been treated with four doses of a homoeopathic oral vaccine for parasitic bronchitis due to Dictyocaulus viviparus and the other with a placebo, were infected at the rate of 25 infective larvae/kg bodyweight 18 days after the final dose. Both groups became severely affected by parasitic bronchitis, with clinical signs starting 13 days after infection. There were no discernible differences between the treated and control groups in their manifestations of resistance to D viviparus or their clinical responses to the disease produced.

Comparison of vaccination and ivermectin treatment in the prevention of bovine lungworm.

Three groups of calves were put out to graze on separate paddocks within a field known to be infected with Dictyocaulus viviparus and were also given a small initial trickle infection of the parasite. The first group were untreated controls, the second were immunised with live irradiated lungworm vaccine and the third were injected three times with ivermectin; the injections taking place after they had grazed for three, eight and 13 weeks. The subsequent infections of D viviparus were estimated by grazing a series of parasite-free tracer calves in the paddocks used by each group. The first group of such calves grazed from July 17 until August 7, the second from August 22 to September 29. During the first half of the grazing season all the untreated and three of the six immunised calves were observed to excrete D viviparus larvae, in contrast to none of the ivermectin-treated group. As a result all the tracer calves on the areas occupied by the untreated and immunised calves became infected with the parasite whereas only one worm was found in one of the 10 tracer calves grazing the area occupied by the ivermectin-treated calves.

Comparison of the efficacy of dermal formulations of ivermectin and levamisole for the treatment and prevention of Dictyocaulus viviparus infection in cattle.

Four groups of six parasite-naive calves were infected at seven day intervals with three doses of infective larvae of Dictyocaulus viviparus. Twenty-one days after the first dose three of the groups were treated either with an injectable formulation of ivermectin at a dose rate of 200 micrograms/kg bodyweight, or with pour-on preparations of levamisole at 10 mg/kg or ivermectin at 500 micrograms/kg. On day 28 two calves from each group were slaughtered and their burdens of lungworms counted. On day 35 the remaining calves were reinfected with D viviparus infective larvae at a rate of 80 L3/kg. The levamisole preparation was 94.6 per cent effective and both ivermectin preparations were 100 per cent effective against the initial infections. The ivermectin-treated calves were protected from the reinfection which subsequently became patent in the levamisole-treated and control calves.

A comparison of interactions between vaccination against Dictyocaulus viviparus and anthelmintic suppression in immunised and unimmunised yearling cattle.

Twenty parasite-naive calves aged approximately four months were divided randomly into four groups of five. Two groups were treated with oral lungworm vaccine. One immunised group plus another non-immunised group were put out to graze on May 1 on a pasture known to be contaminated with Dictyocaulus viviparus infective larvae during the previous autumn. All the calves both indoor and outdoor were treated with ivermectin at three, eight and 13 weeks after the first groups started to graze and again at housing at the end of September. After the winter housing period on April 27 of the following year all the calves were given an artificial challenge of D viviparus infective larvae at the rate of 15 larvae per kg bodyweight, and the clinical and parasitological reactions monitored. All the calves which had been vaccinated or exposed to field infection during year 1 reacted strongly in ELISAs using antigen prepared from fourth stage D viviparus larvae but much less strongly in similar tests using adult derived antigen. Clinically those calves exposed to previous field infections were less severely affected than the housed calves, although parasitologically all three groups with prior exposure to D viviparus appeared to have a similar functional level of immunity to the challenge infection in comparison to the unexposed calves of the same age.

Effects of treatment with topical ivermectin three and eight weeks after turnout on nematode control and the performance of second-season beef suckler cattle.

Two groups of yearling suckled beef calves born between January and May of the preceding year and another two groups of lighter and slightly younger calves born between the previous March and July were grazed during their second year on four separate paddocks known to be contaminated with infective larvae of gastrointestinal nematodes. One of the heavier and one of the lighter groups were treated with a topical formulation of ivermectin three weeks and eight weeks after turnout. The treatment of the heavier group had only relatively minor parasitological effects and no effect on weight gains, whereas the treatment of the lighter cattle resulted in increased weight gains due to effective nematode control. The paper highlights that small differences in previous performances, age and exposure to parasites can have a substantial impact on the benefits accrued from anthelmintic treatment.

Effects of diet on plasma concentrations of oral anthelmintics for cattle and sheep.

Groups of parasite-free lambs and calves which were either housed and fed hay and concentrates or were grazing on pasture were dosed separately with the oral anthelmintics fenbendazole and ivermectin (lambs only). The plasma concentrations of the drugs and their major metabolites were monitored during the period of their metabolism and excretion. The peak plasma concentrations and the availability of the drugs, as estimated by the areas under the plasma concentration-time curves, were significantly less in the grazing animals. When similar groups of lambs were dosed orally with the inert marker chromium EDTA, which has a particle size similar to the anthelmintics, it was observed that a higher percentage of chromium was excreted by the grazing lambs during the first 40 hours after dosing, suggesting that the extent of absorption in the grazing animals was less than in the housed animals.

Immunity to parasitic bronchitis of yearling cattle treated with ivermectin during their first grazing season.

A group of 12 winter-born calves was divided into two groups of six. During the following summer one group grazed on pasture infected with Dictyocaulus viviparus, and was treated with ivermectin injections at three, eight and 13 weeks after turn out. The other group remained housed. Both groups were housed during the winter and then together with a group of younger calves were challenged with a trickle infection of D viviparus larvae at the rate of 25 third stage larvae/kg bodyweight for one month and then slaughtered. The group which had been exposed to previous infection was least affected by parasitic bronchitis and on the basis of serological titres and worm burdens had developed resistance to the challenge infection. The other older group was also more resistant than the younger calves.

The phylogeny and population structure of Mycobacterium bovis in the British Isles.

To further understand the epidemic of bovine tuberculosis in Great Britain, Northern Ireland and the Republic of Ireland, we identified 16 mutations that are phylogenetically informative for Mycobacterium bovis strains from these regions. We determined the status of these mutations among a collection of 501 strains representing the molecular diversity found in these three regions of the British Isles. The resulting linear phylogenies from each region were concordant, showing that the same lineage of M. bovis was present. The dominance of this lineage is unique within Europe, and suggests that in the past the populations were homogenous. Comparison of approximately 500 strains isolated in 2005 from each region by spoligotype and 5 locus VNTR profiling, revealed distinct differences in the genotype frequencies and sub-lineage makeup between each region. We concluded that whilst each region shared the same major phylogenetic lineage of M. bovis, more recent evolution had resulted in the development of region-specific populations. Regional differences in the M. bovis populations suggest that it may be possible to identify the movement of strains from one region to another.

Mycobacterium bovis genotypes in Northern Ireland: herd-level surveillance (2003 to 2008).

Surveillance genotyping (variable number tandem repeat profiling and spoligotyping) of Mycobacterium bovis isolates from culture-confirmed bovine tuberculosis (TB)-affected herds in Northern Ireland is presented for the years 2003 to 2008 inclusive. A total of 175 M bovis genotypes were identified in 8630 isolates from 6609 herds. On average, 73 genotypes were identified each year, with 29 genotypes present in all six years. Highly significant differences (P<0.0001) were observed between the relative frequency of some genotypes in the years 2003 to 2008. The spatial distribution of M bovis genotypes was not random (P<0.0001). Significant geographical localisation of M bovis genotypes was evident, suggesting that sources tended to be local. Despite regions being dominated by geographically localised genotypes, substantial and exploitable local diversity was still evident. Genotypes were also translocated significant distances from their normal geographical location.