Influence of applying different units of measurement on reporting antimicrobial consumption data for pig farms.

BACKGROUND: Antimicrobial use in livestock is one of the factors contributing to selection and spread of resistant microorganisms in the environment. National veterinary antimicrobial consumption monitoring programs are therefore in place in a number of countries in the European Union. However, due to differences in methodology, results on veterinary antimicrobial consumption from these national monitoring programs cannot be compared internationally. International comparison is highly needed to establish regulations on veterinary antimicrobial use and reducing antimicrobial resistance. The aim of this study was to assess differences in the outcomes on veterinary antimicrobial consumption by applying three different sets of nationally established animal defined daily dosages to the same antimicrobial drug delivery dataset of Dutch pigs in 2012. METHODS: Delivery information for the complete Dutch pig sector for the year 2012 reported to the Netherlands Veterinary Medicines Authority (SDa) was analysed with three differently and nationally established animal defined daily dosages from the Netherlands and Denmark: the Defined Daily Dosage AnimalNL (DDDANL), the Animal Daily DosageDK (ADDDK) and Defined Animal Daily DosageDK (DADDDK). For each applied Dutch product equivalent, Danish products were identified based on authorization for pigs, active substance (including form), administration route, concentration and dosage regimen. RESULTS: Consumption in number of ADDDK/Y was lower than in number of DDDANL/Y for sows/piglets and finisher pigs, with proportions of 83.3 % and 98.3 %. Use in number of DADDDK/Y was even lower, 79.7 % for sows/piglets and 88.1 % for finisher pigs compared to number of DDDANL/Y. At therapeutic group level proportions of number of DADDDK/Y to number of DDDANL/Y were 63.6-150.4 % (sows/piglets) and 55.6-171.0 % (finisher pigs). Proportions were > 100 % for the polymyxines (sows/piglets 150.4 % and finisher pigs 149.9 %) and the macrolides/lincosamides (finisher pigs 171.0 %). CONCLUSIONS: Differences between nationally established animal defined daily dosages caused by different correction factors for long-acting products and national differences in authorized dosages, have a substantial influence on the results of antimicrobial consumption in pigs. To enable international comparison of veterinary antimicrobial consumption data, harmonized units of measurement, animal weights and animal (sub) categories are needed.

Endotoxin levels in settled airborne dust in European schools: the HITEA school study.

Indoor exposure to microbial agents is known to influence respiratory health. Besides home exposure, exposure in schools can affect respiratory health. In this study, we measured endotoxin in settled dust in primary schools in three European countries from three different geographical regions with different climates. Our aim was to characterize endotoxin levels in primary schools and evaluate associations with potential determinants. Endotoxin levels were repeatedly assessed in 23 schools in Spain (n = 7), the Netherlands (n = 10), and Finland (n = 6) using electrostatic dustfall collectors. In total, 645 measurements were taken in 237 classrooms. Endotoxin levels differed significantly between countries; Dutch schools had the highest levels, while Finnish schools showed the lowest levels. In each country, differences in endotoxin levels were observed between schools and over the sampling periods. Estimates improved after adjustment for sampling period. Factors affecting endotoxin levels in a school differed per country. In general, endotoxin levels were higher in lower grades and in classrooms with higher occupancy. School endotoxin levels may contribute significantly to total endotoxin exposure in children and teachers. As the correlation between the repeated measurements is reasonable, single endotoxin measurements form a reasonable basis for estimating annual endotoxin levels in schools.

Application of a prediction model for work-related sensitisation in bakery workers.

Identification of work-related allergy, particularly work-related asthma, in a (nationwide) medical surveillance programme among bakery workers requires an effective and efficient strategy. Bakers at high risk of having work-related allergy were indentified by use of a questionnaire-based prediction model for work-related sensitisation. The questionnaire was applied among 5,325 participating bakers. Sequential diagnostic investigations were performed only in those with an elevated risk. Performance of the model was evaluated in 674 randomly selected bakers who participated in the medical surveillance programme and the validation study. Clinical investigations were evaluated in the first 73 bakers referred at high risk. Overall 90% of bakers at risk of having asthma could be identified. Individuals at low risk showed 0.3-3.8% work-related respiratory symptoms, medication use or absenteeism. Predicting flour sensitisation by a simple questionnaire and score chart seems more effective at detecting work-related allergy than serology testing followed by clinical investigation in all immunoglobulin E class II-positive individuals. This prediction based stratification procedure appeared effective in detecting work-related allergy among bakers and can accurately be used for periodic examination, especially in small enterprises where delivery of adequate care is difficult. This approach may contribute to cost reduction.

Wheat allergen exposure and the prevalence of work-related sensitization and allergy in bakery workers.

BACKGROUND: Occupational airway diseases are common among bakers. The present study describes the association between exposure to wheat allergen levels and sensitization to wheat allergens, work-related upper and lower respiratory symptoms and asthma in bakery workers. METHODS: As part of a Health Surveillance System for early detection of (allergic) occupational airway diseases a so-called 'validation study' was performed among Dutch bakers for validation of a diagnostic model that predict the likelihood of sensitization to specific workplace allergens. The present study used serology and questionnaire results of a subgroup of 860 bakers participating in the validation study. An earlier developed job-exposure matrix was used to predict average and cumulative personal exposure to wheat allergens. RESULTS: The prevalence of wheat sensitization, work-related respiratory symptoms and asthma increased till average wheat exposure levels of approximately 25-30 microg/m3, leveled off and decreased at higher exposure concentrations. Exposure-response curves showed a stronger pronounced bell-shape with cumulative exposure. Associations were strongest for asthma and work-related lower respiratory symptoms (PR approximately 2 and PR approximately 3.5-4.5 for average and cumulative exposure, respectively). Associations were only found in atopics. Wheat sensitization was an important factor in the prevalence of respiratory symptoms. CONCLUSION: In accordance with earlier studies, the present study showed a bell-shaped exposure-response relationship especially for cumulative wheat allergen exposure with sensitization, allergic respiratory symptoms and asthma. The healthy worker effect may be the possible explanation for the bell-shaped relationship.

Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers.

The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels. Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied. Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (odds ratio (OR) >1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4-7.2). An excess risk for respiratory symptoms indicative of asthma was observed in swimming pool employees. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations.

Rural-urban child psychopathology in a Northeastern U.S. state: 1986-1989.

Parent and teacher symptom reports from two epidemiological surveys of 2,519 Connecticut children were used to study rural-urban differences in childhood psychopathology. Parents and teachers of girls in cities reported elevated total disturbance and social withdrawal. Parents of urban girls also reported higher rates of behavioral disturbance. For boys, urban excesses were primarily observed in emotional disturbance. Rural-urban variation was largely associated with economic and cultural differences between sites and not with urbanization per se. Findings suggest that certain assumptions about rural-urban differences in specific forms of psychopathology, such as delinquency, should be reevaluated.

Use of a metal ring-marked catheter for geometric calibration in quantitative coronary angiography.

Quantitative coronary angiography depends on accurate measurement of catheter shaft diameter for correction of X-ray magnification errors. We compared the use of coronary catheters with a single metal ring (R), inserted during manufacture, with measurements using the edges of the catheter shaft (S) as a calibration mark. Both ring and shaft were 2.50 mm in diameter. On unmagnified X-ray images, the ring measured 2.49 +/- 0.40 mm, and the shaft measured 2.39 +/- .040 mm in diameter. Quantitative coronary angiography using both ring and shaft for calibration provided the same percent stenosis (R:72 +/- 12; S: 71 +/- 13), but stenosis cross-sectional area was 28% different (R: 1.44 +/- .24; S: 1.84 +/- .34 mm2). Use of the catheter shaft for calibration causes overestimation of actual coronary artery dimensions. To prevent this problem, absolute measurements of coronary artery dimensions should be made with metal ring-marked catheters.

Chronic oesophageal fistulation for studying oropharyngeal and gastric influences on ingestive behaviour in the pigeon.

Surgical and postoperative procedures were developed in the pigeon to study the influence of oropharyngeal and postingestional factors in the control of food and water intake. Pigeons were prepared with an oesophageal fistula so that material swallowed emerged from a tube exteriorized at the neck. Nutrient solutions were injected into the lower portion of the oesophagus through a feeding tube inserted in the fistula. A postoperative tube-feeding regimen, using commercially available laboratory chow, was established to maintain the pigeon at its preoperative weight.

Trial of an anti-inflammatory agent (indomethacin) in low back pain with and without radicular involvement.

A short-term double-blind sequential trial of indomethacin against placebo in the treatment of low back pain, with and without nerve root pain such as sciatica, showed that indomethacin was significantly more effective than placebo in the group with nerve root pain. On the other hand, no difference was found between the treatments in the patients with uncomplicated low back pain. This difference may result from an effect of indomethacin on the inflammatory process around the nerve root which has been shown to be present when this is compressed.