Whole blood long-chain n-3 fatty acids as a measure of fish oil compliance in children with acute lymphoblastic leukemia: a pilot study.

Long-chain n-3 fatty acids (n-3 LCPUFA) may prevent chemotherapy-induced hyperlipidemia in children with acute lymphoblastic leukemia (ALL). However, compliance could be a problem and intake-biomarker correlations may be affected by bodyweight and blood transfusions. We assessed whole blood n-3 LCPUFA three times during the first 83 days of treatment in six 1-17-year-old children with ALL, who received 2.4-4.9 g/d n-3 LCPUFA depending on bodyweight. Mean compliance was 73%, which resulted in a 2.5-fold increase in blood n-3 LCPUFA irrespective of blood transfusions. The correlation between relative blood content of n-3 LCPUFA and intake in g/d across the study period was strong (r=0.76, p=0.001). When n-3 LCPUFA was expressed in absolute concentrations and intake per kg bodyweight the correlation decreased (r=0.39, p=0.164) and was driven by baseline values. Thus, relative content of n-3 LCPUFA in blood reflects fish oil compliance in children with ALL despite blood transfusions and differences in bodyweight.

[Economic importance of antibiotic sale for private food animal practices in Switzerland - example veal production]. / Ökonomische Bedeutung des Umsatzes mit Antibiotika für private Nutztierpraxen in der Schweiz ­ Beispiel Kälbermast.

INTRODUCTION: The use of antibiotics in Swiss veal production is considered an established method for controlling bacterial infectious diseases. Although the veterinary profession aims to ensure animal welfare, the veterinary business income needs to be ensured at the same time. Against the background of increasing problems with resistant pathogens in human and veterinary medicine, the use of antibiotics should be significantly reduced and used more selectively. The associated economic consequences for food animal practitioners are unknown. The aim of this study was to determine the economic importance of antibiotic sale volume for private food animal practitioners in veal production. An anonymized questionnaire was sent to 120 mixed veterinary practices in Switzerland, which offered services to veal and beef cattle farmers. Questions involved the pharmaceutical sale volume, details on veterinary invoices from three farms with average, below and above average animal health throughout 2017. Twenty-nine complete questionnaires (response rate: 24.2%) and veterinary invoices of 84 farms were returned. The study is not representative, but it allows a rough assessment of the economic framework in Swiss livestock practice. The majority of the total turnover with livestock farms was generated by the sale of antibiotics (54%). Antibiotic sales per animal were higher as expected in farms with a below-average animal health than in farms with an average or above-average animal health. Consulting services turnover contributed only 0.5% to the total sale volume in veal farming. The results document, that antibiotic reduction measurements in veal and beef production will have economic consequences for veterinary livestock practices. In the medium term, the profitable existence of livestock veterinary practice requires a change to cost based consulting services.

INTRODUCTION: En Suisse, dans le cadre de la pratique de l'engraissement des veaux, l'utilisation d'antibiotiques est principalement considérée comme une méthode éprouvée pour lutter contre les maladies infectieuses bactériennes. L'activité vétérinaire vise à prévenir ou minimiser les souffrances chez les animaux. Mais pour autant, les vétérinaires restent des entrepreneurs qui doivent assurer un revenu adéquat de leur pratique. Dans un contexte de problèmes croissants rencontrés avec les agents pathogènes résistants en médecine humaine et vétérinaire, l'utilisation d'antibiotiques devrait être considérablement réduite et ciblée. Les conséquences économiques associées pour la pratique vétérinaire rurale sont peu connues. Le but de la présente étude était de déterminer l'importance économique des ventes d'antibiotiques pour les pratiques vétérinaires rurales privées en utilisant l'exemple de l'engraissement des veaux. À cet effet, un questionnaire anonymisé a été envoyé à 120 cabinets vétérinaires mixtes en Suisse, qui s'occupent entre autres d'exploitations d'engraissement de veaux, de broutards et de taurillons. Les participants ont été interrogés sur le niveau des ventes de médicaments. En outre, nous les avons invités à envoyer des factures vétérinaires concernant trois entreprises d'engraissement avec un niveau de santé animale inférieur, égal et supérieur à la moyenne tout au long de l'année 2017. Vingt-neuf questionnaires complets (taux de réponse: 24,2%) ainsi que des factures vétérinaires concernant au total 84 exploitations d'engraissement de veaux, de broutards ou de taurillons nous ont été retournés. L'étude n'est certes pas représentative, mais elle permet une évaluation approximative du cadre économique des pratiques rurales en Suisse. La majorité du chiffre d'affaires total sur les exploitations d'engraissement de veaux, de broutards ou taurillons a été générée par la vente d'antibiotiques (54%). Il apparait que les ventes d'antibiotiques étaient plus élevées dans les exploitations où la santé animale était inférieure à la moyenne que dans les établissements où elle était supérieure ou égale à la moyenne. Le chiffre d'affaires des prestations de conseil ne représentait que 0,5% du chiffre d'affaires total dans le domaine des veaux. Ces résultats montrent que les mesures visant à réduire les antibiotiques dans les conditions actuelles de production de veau et de boeuf auront probablement des conséquences économiques non négligeables sur la part des exploitations d'engraissement dans les revenus des pratiques vétérinaire rurales. A moyen terme, afin d'assurer la rentabilité d'une pratique rurale, une nouvelle orientation de l'activité vétérinaire sera nécessaire: la mise en place d'un service de conseils payants pour les exploitations d'engraissement, ayant pour but l'établissement de concepts de prévention.

Efficacy of a certified modular ultrasound curriculum.

BACKGROUND: In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. OBJECTIVE: The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum. MATERIAL AND METHODS: After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses. RESULTS: Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved. CONCLUSION: This study shows that although this US course curriculum has positively enhanced the trainees' theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.

Population-based food consumption survey as an additional tool for foodborne outbreak investigations, Germany, 2017.

We conducted a food consumption survey in the general adult population of 18 years and older in Germany to obtain data on the frequency of consumption of food items that caused foodborne disease outbreaks in the past. A total of 1010 telephone interviews were completed that queried the consumption of 95 food items in the 7-day period before the interview. Survey results were weighted to be representative. Six exemplary 'high risk' food items were consumed by 6% to 16% of the general population. These were raw ground pork: 6.5%; 'Teewurst' (=spreadable sausage-containing raw pork): 15.7%; unpasteurised milk consumed without prior heating: 9.0%; food items prepared with raw eggs: 9.8%; unheated sprouts or seedlings: 8.8% and frozen berries consumed without prior heating: 6.2%. Data from our food consumption survey were comparable to data obtained from control persons in case-control studies conducted during past foodborne disease outbreak investigations. We consider our survey an additional helpful tool that will allow comparison with food consumption data from case-patients obtained in exploratory, hypothesis-generating interviews early on in outbreak investigations, and which may assist in forming hypotheses regarding associations of illnesses with suspected food vehicles. This may facilitate and accelerate investigations of future foodborne disease outbreaks.

Association between antimicrobial usage, biosecurity measures as well as farm performance in German farrow-to-finish farms.

BACKGROUND: Antimicrobial usage in food producing animals is of major concern. A clear link between the extent of use and the development of antimicrobial resistance has already been demonstrated. To evaluate strategies that may reduce the antimicrobial usage while assuring pig health and welfare, it requires profound knowledge of factors that are associated with antimicrobial usage. Data on biosecurity and herd management practices are important parameters to identify risk factors which are related to a higher antimicrobial usage. To investigate between-farm variations of high and low usage the treatment incidence (TI) per age group in 60 German farrow-to-finish herds was qualitatively and quantitatively analysed and linked to biosecurity measures, and herd management characteristics. RESULTS: Weaned pigs received most of the treatments (median TI = 487.6), followed by suckling pigs (median TI = 138.9). Suckling pigs were treated with critically important antimicrobials (3rd and 4th generation cephalosporines) to a remarkable extent. The number of sows present at site (p < 0.01) and a low score for external biosecurity (p = 0.06) were associated with a higher antimicrobial usage in pigs from birth till slaughter. Herds with a higher treatment incidence in growing pigs (TI 200 days): i) were located in a region with a high pig density (p < 0.01), ii) had a less strict access check for visitors and personnel (p < 0.01) and iii) scored lower in the subcategory 'cleaning and disinfection' (internal biosecurity) (p < 0.01). Herds with a higher treatment incidence in breeding pigs weaned more piglets per sow and year and scored better in the internal biosecurity level (p = 0.02). CONCLUSIONS: With the main focus on the treatment incidence in pigs from birth till slaughter and in breeding pigs risk factors for a high usage in these age groups were identified. The level of biosecurity of a herd was associated with the amount of antimicrobials used. Therefore, the findings in this study indicate possible points of action in the reduction and prudent use of antimicrobials in Germany. The active improvement of biosecurity measures could be a promising alternative to reduce antimicrobial usage on herd level.

Transfer of radionuclides and dose assessment to ants and anthills in a Swedish forest ecosystem.

In forest ecosystems soil organisms are important for immobilization, translocation and recycling of radionuclides. Still, there is a lack of studies on the role of insects such as ants in the turnover of radionuclides and how radioactivity affects an ant community. In this study seven anthills were sampled in an area that was heavily contaminated after the fallout from the Chernobyl accident. Samples of ant and anthill materials were taken from different depths of the anthills as well as from the surrounding soil and the activity concentrations of 137Cs were determined. In addition, a radiation dose assessment was performed for ants and anthills using the ERICA tool. The deposition of 137Cs in 1986 in the study area was calculated back to be on average 110,500 Bq m-2. The averaged data for all the seven locations investigated indicate that the level of 137Cs activity concentrations in the anthill's material increased with depth of the anthill being highest at the depth 50-65 cm. The concentration in the upper layers (0-2 cm) and of the ants showed significant correlations with the deposition upon multivariate analysis. The concentration ratio (CR) defined as the ratio between the mass activity for 137Cs density in ants (Bq kg-1 d.w.) and mass activity density in soil (Bq kg-1 d.w.) was determined to be in the range of 0.04-0.14. Also, the transfer factor (TF) defined as the ratio between the mass activity for 137Cs density in ant (Bq kg-1 d.w.) and to the unit area activity density (in Bq m-2 d.w.) was determined for 137Cs to be 0.0015 m2 kg-1 d.w. The assessed radiation doses were found to be a 4.9 µGy h-1 which is below international reference levels for non-human biota.

Application of multiblock modelling to identify key drivers for antimicrobial use in pig production in four European countries.

Antimicrobial use in pig farming is influenced by a range of risk factors, including herd characteristics, biosecurity level, farm performance, occurrence of clinical signs and vaccination scheme, as well as farmers' attitudes and habits towards antimicrobial use. So far, the effect of these risk factors has been explored separately. Using an innovative method called multiblock partial least-squares regression, this study aimed to investigate, in a sample of 207 farrow-to-finish farms from Belgium, France, Germany and Sweden, the relative importance of the six above mentioned categories or 'blocks' of risk factors for antimicrobial use in pig production. Four country separate models were developed; they showed that all six blocks provided useful contribution to explaining antimicrobial use in at least one country. The occurrence of clinical signs, especially of respiratory and nervous diseases in fatteners, was one of the largest contributing blocks in all four countries, whereas the effect of the other blocks differed between countries. In terms of risk management, it suggests that a holistic and country-specific mitigation strategy is likely to be more effective. However, further research is needed to validate our findings in larger and more representative samples, as well as in other countries.

Using multi-criteria risk ranking methodology to select case studies for a generic risk assessment framework for exotic disease incursion and spread through Europe.

We present a novel approach of using the multi-criteria pathogen prioritisation methodology as a basis for selecting the most appropriate case studies for a generic risk assessment framework. The approach uses selective criteria to rank exotic animal health pathogens according to the likelihood of introduction and the impact of an outbreak if it occurred in the European Union (EU). Pathogens were evaluated based on their impact on production at the EU level and international trade. A subsequent analysis included criteria of relevance to quantitative risk assessment case study selection, such as the availability of data for parameterisation, the need for further research and the desire for the case studies to cover different routes of transmission. The framework demonstrated is flexible with the ability to adjust both the criteria and their weightings to the user's requirements. A web based tool has been developed using the RStudio shiny apps software, to facilitate this.

Hepatitis E virus seroprevalence, seroincidence and seroreversion in the German adult population.

A steep rise in Hepatitis E diagnoses is currently being observed in Germany and other European countries. The objective of this study was (i) to assess whether this trend mirrors an increase in infection pressure or is caused by increased attention and testing and (ii) estimate individual and population-based Hepatitis E Virus (HEV) seroconversion and seroreversion rates for Germany. We measured anti-HEV IgG prevalence in 10 407 adults participating in two linked, population-representative serosurveys (total n = 12 971) conducted in 1998 and 2010. In this period, we found a moderate but statistically significant decline of overall anti-HEV IgG prevalence from 18.6% to 15.3%. At both time points, seroprevalence increased with age and peaked in persons born between 1935 and 1959 suggesting a past period of increased infection pressure. Paired samples of individuals participating in 1998 and 2010 (n = 2564) revealed respective seroconversion and seroreversion rates of 6.2% and 22.6% among seronegative and seropositive individuals during 12 years, or 5.2 and 2.9 per 1000 inhabitants per year. This corresponds to a total of 417 242 [95%CI: 344 363-495 971] new seroconversions per year in the German population. While anti-HEV seroprevalence has decreased in the last decade, infection pressure and seroincidence remains high in Germany. Continuously rising numbers of Hepatitis E diagnoses in Europe are likely due to an increased awareness of clinicians and indicate that still there is a gap between incident and diagnosed cases. Studies on the true burden of the disease, specific risk factors and sources of autochthonous infections as well as targeted prevention measures are urgently needed.

Dynamic interactions of n-3 and n-6 fatty acid nutrients.

Careful handling of data on fatty acid composition is needed when interpreting evidence for the influence of dietary n-3 and n-6 essential fatty acids on brain function and health conditions. The relative dietary supplies of competing n-3 and n-6 nutrients determine the balance of 20- and 22-carbon n-3 and n-6 highly unsaturated fatty acids (HUFA) which accumulate competitively at the 2-position of tissue phospholipids. In turn, the HUFA balance expressed as the %n-6 in HUFA affects the likely intensity of n-6 eicosanoid actions in diverse health conditions. As a result, measures of HUFA balance are important, valid biomarkers for designing and monitoring successful preventive nutrition interventions. Successful interventions must also consider the ability of fatty acid ligands to saturate binding sites of enzymes and receptors and give paradoxical dose-response results.

Herd-specific interventions to reduce antimicrobial usage in pig production without jeopardising technical and economic performance.

Pig farmers are strongly encouraged to reduce their antimicrobial usage in order to reduce the risk of antimicrobial resistance. Herd-level intervention is needed to achieve national and European reduction targets. Alternative, especially preventive measures, have to be implemented to reduce the need for antimicrobial treatments. However, little is known about the feasibility, effectiveness and return on investment of such measures. The objective of this study was to assess, across four countries, the technical and economic impact of herd-specific interventions aiming at reducing antimicrobial usage in pig production while implementing alternative measures. An intervention study was conducted between February 2014 and August 2015 in 70 farrow-to-finish pig farms located in Belgium, France, Germany and Sweden. Herd-specific interventions were defined together with the farmer and the herd veterinarian. Farms were followed over one year and their antimicrobial usage and technical performance were compared with values from the year before intervention. Compliance with the intervention plan was also monitored. Changes in margin over feed cost and net farm profit were estimated in a subset of 33 Belgian and French farms with sufficient data, using deterministic and stochastic modeling. Following interventions, a substantial reduction in antimicrobial use was achieved without negative impact the overall farm technical performance. A median reduction of 47.0% of antimicrobial usage was achieved across four countries when expressed in terms of treatment incidence from birth to slaughter, corresponding to a 30.5% median reduction of antimicrobial expenditures. Farm compliance with intervention plans was high (median: 93%; min-max: 20; 100) and farms with higher compliance tended to achieve bigger reduction (ρ=-0.18, p=0.162). No association was found between achieved reduction and type or number of alternative measures implemented. Mortality in suckling piglets, weaners and fatteners, daily weight gain and feed conversion ratio did not significantly change over the course of the study, while the number of weaned piglets per sow per year slightly increased. The median change in net farm profit among Belgian and French farms was estimated to be €4.46 (Q25-Q75:-32.54; 80.50) and €1.23 (Q25-Q75:-32.55; 74.45) per sow per year using the detererministic and stochastic models, respectively. It was more influenced by a change in feed conversion ratio and daily weight gain than by a change in antimicrobial expenditures or intervention direct net cost. Therefore, costs of alternative measures should not be perceived as a barrier, but rather as an opportunity to optimise production practices for sustained productivity and improved animal health.

Correlates of whole-blood polyunsaturated fatty acids among young children with moderate acute malnutrition.

BACKGROUND: Severe acute malnutrition (SAM) has been associated with low polyunsaturated fatty acid (PUFA) status. However, investigations regarding PUFA status and correlates in children with moderate acute malnutrition (MAM) from low-income countries are scarce. The aim of this study was to describe whole-blood PUFA levels in children with moderate acute malnutrition (MAM) and to identify correlates of PUFAs. METHODS: We conducted a cross-sectional study using baseline data from a prospective nutritional intervention trial among 1609 children with MAM aged 6-23 months in Burkina Faso,West Africa. Whole-blood PUFAs were measured by gas chromatography and expressed as percent of total whole-blood fatty acids (FA%). Potential correlates of PUFAs including infection, inflammation, hemoglobin, anthropometry (difference between children diagnosed as having MAM based on low mid-upper-arm-circumference (MUAC) only, low MUAC and weight-for-height z-score (WHZ), or low WHZ only) and diet were assessed by linear regression adjusted for age and sex. RESULTS: Children with MAM had low concentrations of whole-blood PUFAs, particularly n-3 PUFAs. Moreover, children diagnosed with MAM based only on low MUAC had 0.32 (95% confidence interval (CI), 0.14; 0.50) and 0.40 (95% CI, 0.16; 0.63) FA% lower arachidonic acid (AA) than those recruited based on both low WHZ as well as low MUAC and those recruited with low WHZ only, respectively. Infection and inflammation were associated with low levels of all long-chain (LC)-PUFAs, while hemoglobin was positively associated with whole-blood LC-PUFAs. CONCLUSION: While PUFA deficiency was not a general problem, overall whole-blood PUFA concentrations, especially of n-3 PUFAs, were low. Infection, inflammation, hemoglobin, anthropometry and diet were correlates of PUFAs concentrations in children with MAM. TRIAL REGISTRATION: The trial is registered at http://www.isrctn.com ( ISRCTN42569496 ).

Economics of zoonoses surveillance in a 'One Health' context: an assessment of Campylobacter surveillance in Switzerland.

Cross-sectorial surveillance and general collaboration between the animal and the public health sectors are increasingly recognized as needed to better manage the impacts of zoonoses. From 2009, the Swiss established a Campylobacter mitigation system that includes human and poultry surveillance data-sharing within a multi-sectorial platform, in a 'One Health' approach. The objective of this study was to explore the economics of this cross-sectorial approach, including surveillance and triggered interventions. Costs and benefits of the One Health and of the uni-sectorial approach to Campylobacter surveillance were identified using an economic assessment framework developed earlier. Cost information of surveillance activities and interventions was gathered and disability-adjusted life years (DALYs) associated with the disease estimated for 2008 and 2013. In the first 5 years of this One Health approach to Campylobacter mitigation, surveillance contributed with information mainly used to perform risk assessments, monitor trends and shape research efforts on Campylobacter. There was an increase in costs associated with the mitigation activities following integration, due mainly to the allocation of additional resources to research and implementation of poultry surveillance. The overall burden of campylobacteriosis increased by 3·4-8·8% to 1751-2852 DALYs in 2013. In the timing of the analysis, added value associated with this cross-sectorial approach to surveillance of Campylobacter in the country was likely generated through non-measurable benefits such as intellectual capital and social capital.

Coxiella burnetii Infections in Small Ruminants and Humans in Switzerland.

The recent Q fever epidemic in the Netherlands raised concerns about the potential risk of outbreaks in other European countries. In Switzerland, the prevalence of Q fever in animals and humans has not been studied in recent years. In this study, we describe the current situation with respect to Coxiella (C.) burnetii infections in small ruminants and humans in Switzerland, as a basis for future epidemiological investigations and public health risk assessments. Specific objectives of this cross-sectional study were to (i) estimate the seroprevalence of C. burnetii in sheep and goats, (ii) quantify the amount of bacteria shed during abortion and (iii) analyse temporal trends in human C. burnetii infections. The seroprevalence of C. burnetii in small ruminants was determined by commercial ELISA from a representative sample of 100 sheep flocks and 72 goat herds. Herd-level seroprevalence was 5.0% (95% CI: 1.6-11.3) for sheep and 11.1% (95% CI: 4.9-20.7) for goats. Animal-level seroprevalence was 1.8% (95% CI: 0.8-3.4) for sheep and 3.4% (95% CI: 1.7-6) for goats. The quantification of C. burnetii in 97 ovine and caprine abortion samples by real-time PCR indicated shedding of >104 bacteria/g in 13.4% of all samples tested. To our knowledge, this is the first study reporting C. burnetii quantities in a large number of small ruminant abortion samples. Annual human Q fever serology data were provided by five major Swiss laboratories. Overall, seroprevalence in humans ranged between 1.7% and 3.5% from 2007 to 2011, and no temporal trends were observed. Interestingly, the two laboratories with significantly higher seroprevalences are located in the regions with the largest goat populations as well as, for one laboratory, with the highest livestock density in Switzerland. However, a direct link between animal and human infection data could not be established in this study.

Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals.

An increasing variety of indicators of antimicrobial usage has become available in human and veterinary medicine, with no consensus on the most appropriate indicators to be used. The objective of this review is therefore to provide guidance on the selection of indicators, intended for those aiming to quantify antimicrobial usage based on sales, deliveries or reimbursement data. Depending on the study objective, different requirements apply to antimicrobial usage quantification in terms of resolution, comprehensiveness, stability over time, ability to assess exposure and comparability. If the aim is to monitor antimicrobial usage trends, it is crucial to use a robust quantification system that allows stability over time in terms of required data and provided output; to compare usage between different species or countries, comparability must be ensured between the different populations. If data are used for benchmarking, the system comprehensiveness is particularly crucial, while data collected to study the association between usage and resistance should express the exposure level and duration as a measurement of the exerted selection pressure. Antimicrobial usage is generally described as the number of technical units consumed normalized by the population at risk of being treated in a defined period. The technical units vary from number of packages to number of individuals treated daily by adding different levels of complexity such as daily dose or weight at treatment. These technical units are then related to a description of the population at risk, based either on biomass or number of individuals. Conventions and assumptions are needed for all of these calculation steps. However, there is a clear lack of standardization, resulting in poor transparency and comparability. By combining study requirements with available approaches to quantify antimicrobial usage, we provide suggestions on the most appropriate indicators and data sources to be used for a given study objective.

Active animal health surveillance in European Union Member States: gaps and opportunities.

Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.

Risk factors for Taenia saginata cysticercus infection in cattle in the United Kingdom: A farm-level case-control study and assessment of the role of movement history, age and sex.

Bovine cysticercosis is caused by Taenia saginata cysticercus, the larval stage of the human tapeworm Taenia saginata. Recent European initiatives have highlighted the poor sensitivity of current surveillance for this parasite in cattle at slaughter; calling for more targeted, risk based and cost effective methods of T. saginata cysticercus detection. The aim of this study was to provide evidence that could inform such improved meat inspection activities in the United Kingdom (UK). The study included three components: (i) a farm-level case control study; (ii) the characterization of the network of movements of T. saginata cysticercus infected and non-infected animals, and an assessment of the strength of association between having passed through a farm that had previously originated an infected animal and the risk of infection; (iii) the assessment of the relationship between bovine age and gender and risk of infection. Abattoir records and cattle movement history data were used to identify farms of likely acquisition of infection (case farms) and a suitable control group. A questionnaire was used to gather farm-level characteristics and logistic regression was carried out to identify farm-level risk factors for the production of cattle found to be infected at slaughter. The case-control study provided evidence that farms situated close to a permanent potential source of human faecal contamination, and farms which used manure from animals other than cattle, were at higher risk of producing cattle later found to be infected with T. saginata cysticercus at slaughter. No other farm characteristics were identified as a risk factor for this. Analysis of the networks of animal movements showed that some individual farms played a key role as a source of T. saginata cysticercus infection; it was estimated that cattle with a history of being on a farm which previously appeared in the movement history of an infected animal were 4.27 times (P<0.001; 95% CI: 3.3-5.52) more likely to be diagnosed with T. saginata cysticercus infection at meat inspection. Male cattle aged 20 months or younger at the time of slaughter were found at lower risk of T. saginata cysticercus infection by comparison to other sex or age groups of cattle. These results, in combination with the consultation of experts and stakeholders, led to the conclusion that abattoir-based surveillance in low T. saginata cysticercus prevalence settings, such as Great Britain, could be made more targeted by stratifying cattle based on their individual movement history, sex and age characteristics.

[Epidemiology of age-related macular degeneration]. / Epidemiologie der altersbedingten Makuladegeneration.

Age-related macular degeneration (AMD) is the main cause of blindness in industrialized societies. Population-based epidemiological investigations generate important data on prevalence, incidence, risk factors, and future trends. This review summarizes the most important epidemiological studies on AMD with a focus on their transferability to Germany including existing evidence for the main risk factors for AMD development and progression. Future tasks, such as the standardization of grading systems and the use of recent retinal imaging technology in epidemiological studies are discussed. In Germany, epidemiological data on AMD are scarce. However, the need for epidemiological research in ophthalmology is currently being addressed by several recently started population-based studies.

Higher perceived risk of antimicrobials is related to lower antimicrobial usage among pig farmers in four European countries.

The prudent use of antimicrobials (AMs) should be widened in pig farming to reduce the risk of AM resistance (AMR) in human and veterinary medicine. It is therefore important to understand pig farmers' motivators and the barriers to AM usage (AMU) on their farms. The authors investigated pig farmers' self-estimated levels of AMU, their perceived benefits and risks and the need for AMs in a cross-sectional survey in Belgium, France, Germany and Sweden. The authors also compared these perceptions between the four countries and related them to pig farmers' actual AMU. The results showed that farmers who used more AMs also estimated their own usage as higher. Farmers perceived many benefits but relatively few risks of AMU in pig farming. Some significant cross-country differences in farmers' perceptions were found, but they were relatively small. After controlling for country differences and farm differences, only perceived risks had a significant association with AMU. The authors therefore conclude that in order to promote prudent AMU, it seems most promising to focus on the structural differences in pig farming and veterinary medicine (e.g. legislation, role of the veterinarian) among countries. In addition, interventions which aim at reducing AMU should increase farmers' awareness of the risks of extensive AMU.

Estimating true incidence of O157 and non-O157 Shiga toxin-producing Escherichia coli illness in Germany based on notification data of haemolytic uraemic syndrome.

Shiga toxin-producing Escherichia coli (STEC) is an important cause of gastroenteritis (GE) and haemolytic uraemic syndrome (HUS). Incidence of STEC illness is largely underestimated in notification data, particularly of serogroups other than O157 ('non-O157'). Using HUS national notification data (2008-2012, excluding 2011), we modelled true annual incidence of STEC illness in Germany separately for O157 and non-O157 STEC, taking into account the groups' different probabilities of causing bloody diarrhoea and HUS, and the resulting difference in their under-ascertainment. Uncertainty of input parameters was evaluated by stochastic Monte Carlo simulations. Median annual incidence (per 100 000 population) of STEC-associated HUS and STEC-GE was estimated at 0·11 [95% credible interval (CrI) 0·08-0·20], and 35 (95% CrI 12-145), respectively. German notification data underestimated STEC-associated HUS and STEC-GE incidences by factors of 1·8 and 32·3, respectively. Non-O157 STEC accounted for 81% of all STEC-GE, 51% of all bloody STEC-GE and 32% of all STEC-associated HUS cases. Non-O157 serogroups dominate incidence of STEC-GE and contribute significantly to STEC-associated HUS in Germany. This might apply to many other countries considering European surveillance data on HUS. Non-O157 STEC should be considered in parallel with STEC O157 when searching aetiology in patients with GE or HUS, and accounted for in modern surveillance systems.