Quantifying the spatial risk of Avian Influenza introduction into British poultry by wild birds.

The transmission of pathogens across the interface between wildlife and livestock presents a challenge to the development of effective surveillance and control measures. Wild birds, especially waterbirds such as the Anseriformes and Charadriiformes are considered to be the natural hosts of Avian Influenza (AI), and are presumed to pose one of the most likely vectors for incursion of AI into European poultry flocks. We have developed a generic quantitative risk map, derived from the classical epidemiological risk equation, to describe the relative, spatial risk of disease incursion into poultry flocks via wild birds. We then assessed the risk for AI incursion into British flocks. The risk map suggests that the majority of AI incursion risk is highly clustered within certain areas of Britain, including in the east, the south west and the coastal north-west of England. The clustering of high risk areas concentrates total risk in a relatively small land area; the top 33% of cells contribute over 80% of total incursion risk. This suggests that targeted risk-based sampling in a relatively small geographical area could be a much more effective and cost-efficient approach than representative sampling. The generic nature of the risk map method, allows rapid updating and application to other diseases transmissible between wild birds and poultry.

Assessing effects from four years of industry-led badger culling in England on the incidence of bovine tuberculosis in cattle, 2013-2017.

The objective was to measure the association between badger culling and bovine tuberculosis (TB) incidents in cattle herds in three areas of England between 2013-2017 (Gloucestershire and Somerset) and 2015-2017 (Dorset). Farming industry-selected licensed culling areas were matched to comparison areas. A TB incident was detection of new Mycobacterium bovis infection (post-mortem confirmed) in at least one animal in a herd. Intervention and comparison area incidence rates were compared in central zones where culling was conducted and surrounding buffer zones, through multivariable Poisson regression analyses. Central zone incidence rates in Gloucestershire (Incidence rate ratio (IRR) 0.34 (95% CI 0.29 to 0.39, p < 0.001) and Somerset (IRR 0.63 (95% CI 0.58 to 0.69, p < 0.001) were lower and no different in Dorset (IRR 1.10, 95% CI 0.96 to 1.27, p = 0.168) than comparison central zone rates. The buffer zone incidence rate was lower for Gloucestershire (IRR 0.64, 95% CI 0.58 to 0.70, p < 0.001), no different for Somerset (IRR 0.97, 95% CI 0.80 to 1.16, p = 0.767) and lower for Dorset (IRR 0.45, 95% CI 0.37 to 0.54, p < 0.001) than comparison buffer zone rates. Industry-led culling was associated with reductions in cattle TB incidence rates after four years but there were variations in effects between areas.

Assessing the effects of the first 2 years of industry-led badger culling in England on the incidence of bovine tuberculosis in cattle in 2013-2015.

Culling badgers to control the transmission of bovine tuberculosis (TB) between this wildlife reservoir and cattle has been widely debated. Industry-led culling began in Somerset and Gloucestershire between August and November 2013 to reduce local badger populations. Industry-led culling is not designed to be a randomized and controlled trial of the impact of culling on cattle incidence. Nevertheless, it is important to monitor the effects of the culling and, taking the study limitations into account, perform a cautious evaluation of the impacts. A standardized method for selecting areas matched to culling areas in factors found to affect cattle TB risk has been developed to evaluate the impact of badger culling on cattle TB incidence. The association between cattle TB incidence and badger culling in the first 2 years has been assessed. Descriptive analyses without controlling for confounding showed no association between culling and TB incidence for Somerset, or for either of the buffer areas for the first 2 years since culling began. A weak association was observed in Gloucestershire for Year 1 only. Multivariable analysis adjusting for confounding factors showed that reductions in TB incidence were associated with culling in the first 2 years in both the Somerset and Gloucestershire intervention areas when compared to areas with no culling (incidence rate ratio (IRR): 0.79, 95% CI: 0.72-0.87, p < .001 and IRR: 0.42, 95% CI: 0.34-0.51, p < .001, respectively). An increase in incidence was associated with culling in the 2-km buffer surrounding the Somerset intervention area (IRR: 1.38, 95% CI: 1.09-1.75, p = .008), but not in Gloucestershire (IRR: 0.91, 95% CI: 0.77-1.07, p = .243). As only 2 intervention areas with 2 years of data are available for analysis, and the biological cause-effect relationship behind the statistical associations is difficult to determine, it would be unwise to use these findings to develop generalizable inferences about the effectiveness of the policy at present.

An open-label study to evaluate switching from an SSRI or SNRI to tiagabine to alleviate antidepressant-induced sexual dysfunction in generalized anxiety disorder.

BACKGROUND: This study investigated tiagabine monotherapy in subjects with generalized anxiety disorder (GAD) who had been switched from selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) as a result of antidepressant-induced sexual dysfunction. METHODS: Adults with DSM-IV GAD, an adequate therapeutic response (> or =50% decrease in Hamilton Rating Scale for Anxiety [HAM-A] total score) to SSRI or SNRI and sexual dysfunction were switched to open-label tiagabine 4-12 mg/day for 14 weeks. Assessments included the HAM-A, Hospital Anxiety & Depression Scale (HADS) and the Arizona Sexual Experiences Scale (ASEX); assessments were made at baseline and at Weeks 4, 8, and 14. RESULTS: Twenty six subjects were included in the analysis. Tiagabine showed no worsening in baseline symptoms of GAD, with non-significant changes from baseline in mean HAM-A total scores and HADS Anxiety and Depression subscale scores. There was a significant (p < 0.001) reduction in ASEX total scores from baseline following tiagabine, indicating an alleviation of sexual dysfunction. Tiagabine was reasonably tolerated; the most commonly reported adverse events were dizziness/light headedness (n = 6; 23%), nausea (n = 6; 23%) and fatigue (n = 2; 8%). CONCLUSIONS: Tiagabine may be useful in subjects who respond to previous antidepressant therapy but develop sexual dysfunction as an adverse event.

Tadalafil reversal of sexual dysfunction caused by serotonin enhancing medications in women.

Sexual dysfunction is a common side effect of many antidepressants, especially those that increase serotonin. Many strategies have been reported to assist patients in minimizing impairment, with variable degrees of success. One of the newer approaches is to augment with phosphodiesterase type-5 inhibitors. Our report using the most recently released agent in this class, tadalafil is the first demonstrating potential benefit in women. We report here of three women who derived benefit from using 20 mg of tadalafil before anticipated sexual activity to reverse medication-induced sexual dysfunction. Tadalafil utility was maintained over time and was well tolerated.

Improvements in SSRI/SNRI-induced sexual dysfunction by switching to escitalopram.

Antidepressants, especially serotonin reuptake inhibiting agents, are associated with sexual dysfunction. The newest drug of this class, escitalopram, claims greater tolerability than older alternatives. This study evaluated patient experiences with switching from one serotonin enhancing antidepressant to escitalopram in individuals who already were complaining of antidepressant-induced sexual dysfunction. We found that 68.1% of patients experienced improvement with their sexual function. The ability to obtain a satisfactory clinical response at relatively low doses may explain this finding. We performed gender, phase of sexual response,and dose analyses. This article discusses results and significance.

Antidepressant-related adverse effects impacting treatment compliance: Results of a patient survey.

BACKGROUND: Despite the high prevalence of depression in the United States, 10 few studies have identified which adverse effects (AEs) patients are willing or unwilling to tolerate when receiving antidepressants. OBJECTIVE: The aim of this study was to identify reasons for discontinuation10 and noncompliance with antidepressant medications, the impact of AEs on compliance and quality of life (assessed using impact of AEs on activities of daily living), and patients' suggestions for improving their medication, using a patient survey. METHODS: Patients aged 18 to 65 years with mild to severe depression were 10 randomly selected by their physicians to be sent an invitation to complete the 42-question survey. Three hundred physicians nationwide assessed the severity of depression and symptoms of anxiety in each respondent, using their judgment. Patients were asked specific questions to assess reasons for discontinuation/noncompliance. Patients were also asked to rate AEs based on how difficult they were to "live with," and what 2 aspects of their antidepressant medication they would change if they could. RESULTS: In a separate, concurrent study, physicians classified 175 (50%) abdResults:0 mildly to moderately depressed and 84 (24%) as severely depressed. Ninety-one respondents (26%) were classified as having symptoms of anxiety. Two hundred seven patients (60%) indicated they had discontinued treatment with an antidepressant agent at some point in their lives, the most common reason for which was lack of efficacy (92 patients [44%]). Of the 344 patients currently being treated with an antidepressant, 75 (22%) reported noncompliance. The most common reasons for noncompliance were "have trouble remembering to take it" (19/44 patients [43%]), "gained a lot of weight" (11/41 [27%]), "unable to have an orgasm" (8/40 [20%]), and "lost interest in sex" (8/41 [20%]). The 4 AEs patients expressed as "extremely difficult to live with" were "weight gain" (104 patients [31%]), "unable to have erection" (83 [25%]), "difficulty reaching orgasm" (80 [24%]), and "tired during the day/no energy" (69 patients [21%]). The 3 most frequently cited improvements patients (n = 327) would make to their medications were better efficacy (176 patients [54%]) and eliminating AEs related to sexual desire and weight gain (112 [34%] and 105 [32%] patients, respectively). CONCLUSIONS: The findings of this survey of patients with mild to severe10 depression suggest that compliance, and hence efficacy, can be promoted by (1) understanding what patients expect and desire from the antidepressants they are prescribed and (2) prescribing antidepressants associated with low rates of weight gain, sexual dysfunction, or tiredness.

Reversal of fluoxetine-induced sexual dysfunction by switching to escitalopram.

Sexual dysfunction is a common complaint among patients taking selective serotonin reuptake-inhibiting (SSRI) antidepressants. Many options in managing this side effect have been described but none clearly is a first choice among clinicians. This paper describes the first published case of a patient having successful reversal of SSRI-induced sexual dysfunction by switching from an SSRI to escitalopram, the newest antidepressant and SSRI approved for use in the United States. Clinical implication is discussed.