Pharmaceutical policies: effects of cap and co-payment on rational drug use.

BACKGROUND: Growing expenditures on prescription drugs represent a major challenge to many health systems. Cap and co-payment (direct cost-share) policies are intended as an incentive to deter unnecessary or marginal utilisation, and to reduce third-party payer expenditures by shifting parts of the financial burden from the insurer to patients, thus increasing their financial responsibility for prescription drugs. Direct patient drug payment policies include caps (maximum number of prescriptions or drugs that are reimbursed), fixed co-payments (patients pay a fixed amount per prescription or drug), coinsurance (patients pay a percent of the price), ceilings (patients pay the full price or part of the cost up to a ceiling, after which drugs are free or available at reduced cost), and tier co-payments (differential co-payments usually assigned to generic and brand drugs). OBJECTIVES: To determine the effects of cap and co-payment (cost-sharing) policies on drug use, healthcare utilisation, health outcomes and costs (expenditures). SEARCH STRATEGY: We searched the following databases and web sites: Effective Practice and Organisation of Care Group Register (date of last search: 6 September 07), Cochrane Central Register of Controlled Trials (27 August 07), MEDLINE (29 August 07), EMBASE (29 August 07), NHS EED (27 August 07), ISI Web of Science (09 January 07), CSA Worldwide Political Science Abstracts (21 October 03), EconLit (23 October 03), SIGLE (12 November 03), INRUD (21 November 03), PAIS International (23 March 04), International Political Science Abstracts (09 January 04), PubMed (25 February 04), NTIS (03 March 04), IPA (22 April 04), OECD Publications & Documents (30 August 05), SourceOECD (30 August 05), World Bank Documents & Reports (30 August 05), World Bank e-Library (04 May 05), JOLIS (22 February 06), Global Jolis (22 February 06), WHOLIS(22 February 06), WHO web site browsed (25 August 05). SELECTION CRITERIA: We defined policies in this review as laws, rules, or financial or administrative orders made by governments, non-government organisations or private insurers. We included randomised controlled trials, non-randomised controlled trials, interrupted time series analyses, repeated measures studies and controlled before-after studies of cap or co-payment policies for a large jurisdiction or system of care. To be included, a study had to include an objective measure of at least one of the following outcomes: drug use, healthcare utilisation, health outcomes or costs (expenditures). DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed study limitations. We undertook quantitative analysis of time series data for studies with sufficient data. MAIN RESULTS: We included 30 evaluations (in 21 studies). Of these, 11 evaluated fixed co-payment, six evaluated coinsurance with a ceiling, four evaluated caps, three evaluated fixed co-payment with a ceiling, three evaluated tier co-payment, one evaluated ceiling, one evaluated fixed co-payment and coinsurance with a ceiling, and one evaluated a fixed co-payment with a cap. Most of the included evaluations were observational studies and the quality of the evidence was found to be generally low to moderate. Introducing or increasing direct co-payments reduced drug use and saved plan drug expenditures across studies. Patients responded through drug discontinuation or by cost-sharing. Investigators found reductions for life-sustaining drugs or drugs that are important in treating chronic conditions as well as other drugs. Few studies reported on the effects on health and healthcare utilisation. One study found adverse effects on health through increased healthcare utilisation when a cap was introduced in a vulnerable population. No statistically significant change in use of healthcare services was found in other studies when a cap was introduced on a drug considered over-prescribed in a vulnerable population, or following a shift from a two-tier to a three-tier system with increased co-payments for tier-1 drugs in a general population. AUTHORS' CONCLUSIONS: We found a diversity of cap and co-payment policies. Poor reporting of the intensity of interventions and differences in setting, populations and interventions made it difficult to make comparisons across studies. Cap and co-payment polices can reduce drug use and save plan drug expenditures. However, although insufficient data on health outcomes were available, substantial reductions in the use of life-sustaining drugs or drugs that are important in treating chronic conditions may have adverse effects on health, and as a result increase the use of healthcare services and overall expenditures. Direct payments are less likely to cause harm if only non-essential drugs are included or exemptions are built in to ensure that patients receive needed medical care.

Pharmaceutical policies: effects of financial incentives for prescribers.

BACKGROUND: Pharmaceuticals, while central to medical therapy, pose a significant burden to health care budgets. Therefore regulations to control prescribing costs and improve quality of care are implemented increasingly. These include the use of financial incentives for prescribers, namely increased financial accountability using budgets and performance based payments. OBJECTIVES: To determine the effects on drug use, healthcare utilisation, health outcomes and costs (expenditures) of policies, that intend to affect prescribers by means of financial incentives. SEARCH STRATEGY: We searched the following databases and web sites: Effective Practice and Organisation of Care Group Register (August 2003), Cochrane Central Register of Controlled Trials (October 2003), MEDLINE (October 2005), EMBASE (October 2005), and other databases. SELECTION CRITERIA: Policies were defined as laws, rules, financial and administrative orders made by governments, non-government organisations or private insurers. One of the following outcomes had to be reported: drug use, healthcare utilisation, health outcomes, and costs. The study had to be a randomised or non-randomised controlled trial, interrupted time series analysis, repeated measures study or controlled before-after study evaluating financial incentives for prescribers introduced for a jurisdiction or healthcare system. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed study limitations. MAIN RESULTS: Thirteen evaluations of budgetary policies and none of performance based payments met our inclusion criteria. Ten studies evaluated general practice fundholding in the UK, one the Irish Indicative Drug Target Savings Scheme (IDTSS) and two evaluated German drug budgets for physicians in private practice. The interrupted time series analyses had some limitations. All the controlled before-after studies (all from the UK) had serious limitations. Drug expenditure (per item and per patient) and prescribed drug volume decreased with budgets in all three countries. Evidence indicated increased use of generic drugs in the UK and Ireland, but was inconclusive on the use of new and expensive drugs. We found no clear evidence of increased health care utilisation and no studies reporting effects on health. Administration costs were not reported. No studies on the effects of performance-based payments or other policies met our inclusion criteria. AUTHORS' CONCLUSIONS: Based on the evidence in this review from three Western European countries, drug budgets for physicians in private practice can limit drug expenditure by limiting the volume of prescribed drugs, increasing the use of generic drugs or both. Since the majority of studies included were found to have serious limitations, these results should be interpreted with care.

Pharmaceutical policies: effects of reference pricing, other pricing, and purchasing policies.

BACKGROUND: Pharmaceuticals can be important for people's health. At the same time drugs are major components of health care costs. Pharmaceutical pricing and purchasing policies are used to determine or affect the prices that are paid for drugs. Examples are price controls, maximum prices, price negotiations, reference pricing, index pricing and volume-based pricing policies. The essence of reference pricing is to establish a maximum level of reimbursement for a group of drugs assumed to be therapeutically equivalent. OBJECTIVES: To determine the effects of pharmaceutical pricing and purchasing policies on drug use, healthcare utilisation, health outcomes and costs (expenditures). SEARCH STRATEGY: We searched the following databases and web sites: Effective Practice and Organisation of Care Group Register (date of last search: 22/08/03), Cochrane Central Register of Controlled Trials (15/10/03), MEDLINE (07/09/05), EMBASE (07/09/05), ISI Web of Science (08/09/05), CSA Worldwide Political Science Abstracts (21/10/03), EconLit (23/10/03), SIGLE (12/11/03), INRUD (21/11/03), PAIS International (23/03/04), International Political Science Abstracts (09/01/04), NHS EED (20/02/04), PubMed (25/02/04), NTIS (03/03/04), IPA (22/04/04), OECD Publications & Documents (30/08/05), SourceOECD (30/08/05), World Bank Documents & Reports (30/08/05), World Bank e-Library (04/05/05), JOLIS (22/08/05), Global Jolis (22/08/05 and 23/08/05), WHOLIS (29/08/05). SELECTION CRITERIA: Policies in this review were defined as laws, rules, financial and administrative orders made by governments, non-government organisations or private insurers. To be included a study had to include an objective measure of at least one of the following outcomes: drug use, healthcare utilisation, health outcomes, and costs (expenditures); the study must be a randomised controlled trial, non-randomised controlled trial, interrupted time series analysis, repeated measures study or controlled before-after study of a pharmaceutical pricing or purchasing policy for a large jurisdiction or system of care. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study limitations. Quantitative analysis of time series data, for studies with sufficient data, and qualitative analyses were undertaken. MAIN RESULTS: We included 10 studies of reference pricing and one study of index pricing. Most of the reference pricing studies were for senior citizens in British Columbia, Canada. The use (dispensing) of reference drugs increased in five studies, between 60% and 196% immediately after introduction of reference drug pricing, whereas the use of cost sharing drugs decreased by between 19% and 42% in four studies. In three studies the reference drug group expenditures decreased (range 19% - 50%), whereas in the fourth study the expenditures increased by 5% in the short term. The results after six months of reference pricing do not show any clear pattern in relationship to the immediate effects. We found no evidence of adverse effects on health and no clear evidence of increased health care utilisation. For index pricing the evidence was much more limited than for reference drug pricing. A small reduction in drug prices was found. AUTHORS' CONCLUSIONS: We found relatively few studies of pricing policies. The majority of the studies dealt with reference pricing. They had few methodological limitations. Based on the evidence in this review, mostly from senior citizens in British Columbia, Canada, reference drug pricing can reduce third party drug expenditures by inducing a shift in drug use towards less expensive drugs. We found no evidence of adverse effects on health and no clear evidence of increased health care utilisation. The analysis and reporting of the effects on patient drug expenditures were limited in the included studies and administration costs were not reported.

Regular self-examination or clinical examination for early detection of breast cancer.

BACKGROUND: Breast self-examination and clinical breast examination have been promoted for many years as general screening methods to diagnose breast cancer at an earlier stage in order to decrease morbidity and or mortality. The possible benefits and harms remain unclear. OBJECTIVES: To determine whether screening for breast cancer by regular self-examination or clinical breast examination reduces breast cancer mortality and morbidity. SEARCH STRATEGY: The Cochrane Library and Medline were searched for randomised trials; date of last search October 2002. The specialised register maintained by the Cochrane Breast Cancer Group was searched. SELECTION CRITERIA: Randomised clinical trials, including cluster randomised trials. DATA COLLECTION AND ANALYSIS: Decisions on which trials to include were taken independently by the reviewers based on the methods of trial. Disagreements were resolved by discussion. Intention to treat analyses were conducted using a fixed effect model with 95% confidence intervals. MAIN RESULTS: Two large population-based studies (388,535 women) from Russia and Shanghai that compared breast self-examination with no intervention were included. There was no statistically significant difference in breast cancer mortality, relative risk 1.05 (95% confidence interval (CI) 0.90 to 1.24) (587 deaths in total). In Russia, more cancers were found in the breast self-examination group than in the control group (relative risk 1.24, 95% CI 1.09 to 1.41), while this was not the case in Shanghai (relative risk 0.97, 95% CI 0.88 to 1.06). Almost twice as many biopsies (3406) with benign results were performed in the screening group compared to the control group (1856), relative risk 1.89, 95% CI 1.79 to 2.00. REVIEWER'S CONCLUSIONS: Data from two large trials do not suggest a beneficial effect of screening by breast self-examination whereas there is evidence for harms. There were no randomised trials of clinical breast examination. At present, breast self-examination cannot be recommended.

Avian paramyxovirus serotype 1 isolates from the spinal cord of parrots display a very low virulence.

The spinal cord of 32 psittacines suffering from proventricular dilatation disease (PDD) was investigated. In six cases, a virus was isolated which upon electron microscopic examination revealed morphological details typical of members of the Paramyxoviridae. All isolates were subsequently characterized as avian paramyxovirus serotype 1 (APMV-1) by type-specific polyclonal antisera. According to their reactivity with APMV-1 specific monoclonal antibodies, the six isolates shared epitopes within the haemagglutinin-neuraminidase spike protein, distinct from pigeon-type paramyxoviruses and the LaSota vaccine strain. This grouping was further corroborated by properties of the haemagglutinin: all isolates showed a very thermosensitive haemagglutination activity and were rapid eluters. Virulence of the APMV-1 isolates in 1-day-old specific pathogen free (spf) chicken was very low, with intracerebral pathogenicity indices between 0 and 0.1. In embryonated spf chicken eggs, psittacine isolates replicated to high titres (10(8.6)-10(10.7) EID50/ml). However, they exhibited a reduced lethality over an observation time of 7 days (10(6.1)-10(8.3) ELD50/ml). In a haemagglutination inhibition test with parrot sera from birds with no history of APMV-1 vaccination, sera reacted preferentially with two isolates compared with APMV-1 vaccine strains LaSota and B1. The other four isolates exhibited a differentiated reaction pattern with the parrot sera, indicating an antigenic inhomogeneity. This is the first report of isolating very low virulent APMV-1 from neuronal tissue of parrots and implications for a possible role in slow progressing disease will be discussed.

Bumblefoot and lack of exercise among wild and captive-bred falcons tested in the United Arab Emirates.

In the 1990s, bumblefoot posed a major health problem to the falcons in the United Arab Emirates. This retrospective study based on statistical field research showed that in captivity wild falcons need a training frequency of twice a day to reduce the bumblefoot morbidity rate. In this context, they responded very well to free flight in aviaries during the molting season. In contrast, captive-bred falcons did not show a highly significant difference regarding training frequencies. Wild falcons tested fed with pigeons, bustards, and ducks suffered significantly less from bumblefoot compared with those fed a diet of quail. Apart from the disease-reducing impact of beef and mice, captive-bred falcons tested did not show any significant difference regarding the influence of diet on the bumblefoot occurrence.

Enteropathogenic Escherichia coli in Psittaciformes.

A total of 103 Escherichia coli isolates from psittaciform birds were examined for the presence of genes coding for shigatoxin 1 (Stx1), shigatoxin 2 (Stx2) and for intimin (eae), using the polymerase chain reaction (PCR). Sixty-eight E. coli strains were isolated from necropsy cases and faecal samples, the other 35 were from 205 cloacal swabs from Psittaciformes with various conditions. All isolates were tested for enterohaemorrhagic E. coli-haemolysin (HlyEHEC), some also for Stx production, but there was no geno-typic or phenotypic evidence of Stx in any of them. Seven isolates, six from birds with diarrhoea, harboured the eae gene, three of them belonging to the O110:H6 serotype, one each to serotypes O153:H10, O131:H-, O63:H6 and Osp:H6. These seven eae-positive strains were negative for shigatoxin and HlyEHEC, and the hlyEHEC gene was not detectable by PCR. However, a PCR amplifying the enteropathogenic E. coli (EPEC)-specific bundle-forming pili structural gene bfpA detected four bfpA positive strains (three of serotype O110:H6, one O131:H-) among the seven eae positive strains, which classifies them as EPEC. Our findings suggest that shigatoxin-producing E. coli are uncommon, but that EPEC should be considered as potential pathogens in psittaciform birds, which may be a source of human EPEC infections.

[Appearance of antibodies against Borrelia burgdorferi in different populations of pigeons (Columba livia var. domestica vel urbana]. / Untersuchungen zum Vorkommen von Antikörpern gegen Borrelia burgdorferi in verschiedenen Taubenpopulationen (Columba livia var. domestica vel urbana).

Borrelia burgdorferi, the causative agent of Lyme borreliosis, can infect both mammals and birds. The purpose of the present survey was to determine the presence of antibodies against B. burgdorferi in different populations of pigeons. 1043 sera from pigeons (carrier-, urban-, show-pigeons) were examined by standard serological methods. B.burgdorferi shows crossreaction with B. anserina. Therefore all sera were evaluated by IFAT and ELISA for both Borrelia species. The results demonstrate no evidence for the pigeons (Columba livia var. domestica vel urbana) to be reservoir for Borrelia burgdorferi.

[The problem of free living urban pigeons]. / Zur Problematik der freilebenden Stadttauben.

The biology and behaviour of urban pigeons is presented in this article. When changes in the population density of pigeons by capture, shooting, or intoxication are intended, the breeding behaviour has to be considered. A constant reduction of pigeons according to the law for the prevention of cruelty against animals can only be achieved by a restricted feeding if feeding at all.

Surveillance on Salmonella in turkey flocks and processing plants.

The present investigation was carried out to investigate the occurrence and distribution of Salmonella infection on all stages of turkey production. Therefore, samples from turkey parent flocks, hatchery, meat turkey flocks, turkey feed and finally from the surveillanced flocks at different steps in processing plant were examined. Salmonella was isolated from 4 out of 6 turkey parent flocks (66.7%), but none of the examined 485 samples from the hatchery revealed positive Salmonella results. Eight out of 24 monitored meat turkey flocks were free from Salmonella during the entire rearing period (33.3%); seven flocks (29.2%) appeared to be infected with only one serovar and in another 9 flocks (37.5%) two or more different serovars were isolated during the rearing period, in some cases at the same time. In 20 out of 506 examined feed samples Salmonella was isolated (3.95%). During processing, bacteriological investigations on the presence of Salmonella were carried out on the monitored flocks at different processing steps. Cross contamination seems to be very common during processing and even in several flocks contamination appeared to have started already during transport.

Studies on reactivation and transmission of pigeon herpes virus (PHV) for raising PHV-free pigeons (Columba livia dom.).

For raising pigeons free of herpes virus infection, 12 parental pigeons were monitored for shedding of pigeon herpes virus (PHV) during 18 weeks of reproduction. In most of the birds only a sporadic virus excretion, which was never associated with clinical signs could be observed. However, three out of seven squabs raised by their parents became infected during the first 3 weeks of life and all seven became PHV seropositive within 4 months. Therefore, we raised seven squabs hatched in an incubator by hand using heat-inactivated crop milk. By this method we were able to obtain pigeons free of PHV infection, i.e. no virus could be isolated during the first 5 weeks of life and they remained seronegative during an observation period of 8 months. These animals have been assigned to breed a live-stock of PHV -free pigeons, necessary for studies on the pathogenesis of PHV and other pathogens.

[Ostrich farming from the perspective of veterinarians]. / Straussenhaltung aus der Sicht des Tierarztes.

The present paper is an attempt to relate the etiology of 54 cases with diseased/deceased ostriches to criterions of keeping, feeding, climate and infectious diseases. Despite the fact that some of the damages diagnosed seem to be avoidable the criterions of the law for the prevention of cruelty to animals are not to be fulfilled since the adverse climatic circumstances in Germany.

[Some legal aspects of bird keeping under wild or free-flying conditions]. / Einige rechtliche Aspekte der Wild- oder Freiflughaltung verschiedener Vogelarten.

Keeping birds under freeflying conditions means that these birds come back to their owners regularly and by free will. We give some examples for this form of birdkeeping, taking in mind the following legal regulations: the German law for animal protection, the German federal law for nature protection, the German hunting regulation, the German civil law, and others.

[Determination of the activity of delta-aminolevulinic acid dehydratase--a method for the diagnosis of lead poisoning in birds]. / Die Aktivitätsbestimmung der Delta-Aminolävulinsäure-Dehydratase--ein Verfahren zur Diagnose von Bleiintoxikationen bei Vögeln.

In avian patients enteral, parenteral and aerogenous lead intoxications are frequently observed. Ingestion of non-metallic lead may not be diagnosed by radiography. Alternatively, estimation of the delta-aminolevulinic acid dehydratase (delta-ALA Dehydratase) activity is a suitable diagnostic test for lead intoxications. The enzyme delta-ALA Dehydratase, which plays a central role in erythropoiesis, is inhibited by lead and is therefore a specific indicator for lead intoxications. The activity of delta-ALA Dehydratase is measured directly in the blood; not the amount of excreted delta-ALA in the urine as in mammals. Blood volumes of 0.45 ml are necessary and thus allow to perform the test in birds as small as 45 g body weight (e.g. Budgerigars). Possible ranges of application as well as a suitable therapy for lead intoxication in birds are presented.

[Evaluation of three commercial ELISA test kits for the detection of antibodies against Salmonella enteritidis]. / Beurteilung von drei kommerziellen ELISA-Teskits zum Nachweis von Antikörpern gegen Salmonella enteritidis.

We evaluated three commercial enzyme-linked immunoassay (ELISA) test-kits, using either lipopolysaccharide (LPS) or flagellar extracts as antigens, for the demonstration of Salmonella enteritidis (S. e.) antibodies in serum and egg yolk. They were also compared with conventional serological tests, such as the pullorum rapid slide agglutination test (RST), the pullorum slow agglutination tube test and a rapid slide agglutination test, using gm flagellar extracts as antigen. We tested sera and eggs from six different layer flocks. In 84.1 to 90% of the sera and egg yolks tested the three commercial ELISA test kits gave comparable results. There were a number of serological cross-reaction with other serovars, particularly S. typhimurium. However, the possibility of infections with more than one salmonella serovar, other than S. e., cannot be excluded. The ELISA-antibody levels in serum and egg yolk ran parallel and were still high after one year. However, the level of egg yolk antibodies was on an average 33.9% lower than in serum. The S. e.-ELISA seems to be well suited for epidemiological investigations and for preventive and control measures.

Investigations on the aerobic flora and Clostridium perfringens in fecal specimens from free-living and captive capercaillies (Tetrao urogallus L., 1758).

173 fecal specimens from captive Capercaillies and 92 fecal specimens from free-living Capercaillies were examined bacteriologically. With all specimens the bacteriological examination was limited to the aerobic bacteria which can be isolated by the usual methods and to Clostridium perfringens. The occurrence of fungi and parasites was examined as well. The present paper compares the results of these examinations. The identifiable fecal flora of free-living Capercaillies consists of few species with low colony numbers. In about half of the specimens Bacillus spp. are the main aerobic component while only a small number of the fecal specimens contain Escherichia coli and Streptococcus spp. None of the literature to date has stated that Streptococcus spp. do not belong to the autochthonous fecal or intestinal flora of an avian species. Clostridium perfringens cannot be isolated. The identifiable fecal flora of captive Capercaillies consists of many species with high colony numbers. Almost all fecal specimens contain Escherichia coli and various Bacillus spp. Streptococcus spp. can be isolated frequently, other enterobacteriaceae and Clostridium perfringens are present. The results of the examinations for fungi and parasites only differ slightly from those in wild birds.

Investigations on the antibacterial effect of conifer needle oils on bacteria isolated from the feces of captive Capercaillies (Tetrao urogallus L., 1758).

In winter, free-living Capercaillies feed almost exclusively upon needles of various conifer species. An important part of the energy and protein requirements of captive Capercaillies, however, is supplied by food rich in starch and proteins. The fecal flora of captive Capercaillies is considerably different from the flora of free-living Capercaillies. Bacterial diseases are frequent in captivity. The aim of the present study is to determine whether the essential oils from conifer needles possess antibacterial properties against several bacteria, some of which are facultatively pathogenic for Capercaillies. Needles of Pinus sylvestris contain few tannins, which could be a reason for the Capercaillies' preference for these needles. The needles of Abies alba contain high amounts of tannins and essential oils, which could explain the refusal of Capercaillies to eat these needles. The antibacterial effect of commercially available essential oils on the bacteria is investigated with a filter paper disc method and in a liquid medium. The essential oils possess a bacteriostatic or a bactericidal effect against some of the tested bacteria. Feeding on natural forage plants may help prevent the colonization of the intestines by facultatively pathogenic bacteria. The authors discuss why Capercaillies, especially young birds that are to be released, should be fed with natural forage plants.

[The problems of making birds unable to fly and questions of raising waterfowl in ponds from the viewpoint of animal welfare]. / Zur Problematik der Flugunfähigmachung von Geflügel und zu Fragen der Teichhaltung von Wassergeflügel aus der Sicht des Tierschutzrechts.

From the viewpoint of the current law on animal welfare, the methods of rendering birds flightless are described and evaluated. Besides the animal welfare, other law statutes are to be paid attention to obligatory when waterfowl is kept on ponds. The raising and fattening of ducks and geese without water to swim on, can also be advocated from the angle of animal welfare.

[The aerobic bacterial flora of songbird nests]. / Untersuchungen über die aerobe Bakterien-Flora von Singvogelnestern.

In the area around Ober- and Unterschleissheim, a medium term decrease in the singing bird population appears to be happening. Therefore, material from nesting-boxes (used for nesting or sleeping) was examined for bacterial contamination. Mainly gram positive bacteria were isolated which were considered to belong to the normal flora. The occurrence of Streptomyces spp. is described in the nesting material of Passeres probably for the first time. Enterobacteriaceae represent only a fraction of the total isolates, but are demonstrated relatively frequently in the nests of the Nuthatch (Sitta europaea) and nests of other non-identified bird spp., so that colonization of the intestinal tract with Enterobacteriaceae cannot be excluded. Surprisingly, bacteria of the aquatic habitats such as Alcaligenes, Bordetella, Aeromonas, Non-Cholera (NC)-Vibrio were isolated, although in small amounts. The occurrence of NC-Vibrio has not yet been described in singing birds. Nests with high numbers of gram negative rods were successful in most instances, therefore, there was no proof that aerobic bacteria are responsible for the decrease in the population.