Shifting from an individual to an organizational perspective in work environment management - a process evaluation of a six-year intervention program within the Swedish public sector.

BACKGROUND: Working systematically with the work environment, particularly the organizational and psychosocial work environment entails several challenges for employers. There is a lack of knowledge on how to best undertake this work. Thus, the aim of this study is to evaluate the process of a six-year organizational-level intervention program where workplaces could apply for additional funds to implement preventive intervention measures, with the intention of improving working conditions and reducing sickness absence within the Swedish public sector. METHODS: The program management process was studied using a mixed-method approach combining qualitative document and content analyses based on process documentation produced between 2017 and 2022 (n = 135), interviews with internal occupational health services professionals in 2021 (n = 9) and quantitative descriptive analyses of submitted applications with decisions from 2017 to 2022 (n = 621). RESULTS: Qualitative analyses of the process documentation revealed concerns from the project group regarding access to sufficient competence and resources among stakeholders and participating workplaces, and role conflicts and ambiguities between the program and everyday operations. To address these challenges, the application process was developed over time using the knowledge gained from previous years. A change in the mental models in work environment management, from an individual to an organizational perspective, was seen among the project group and the internal occupational health services responsible for implementing most of the granted intervention measures. In addition, the proportion of granted intervention measures on an organizational level increased throughout the years from 39% in 2017 to 89% in 2022. The changes in the application process were believed to be the main contributor to the change among the applying workplaces. CONCLUSIONS: Results indicate that a long-term organizational-level workplace intervention program may be used, by the employer, as a tool for shifting from an individual- to an organizational perspective in the work environment management. However, additional measures on multiple levels need to be implemented to secure a sustainable shift in perspective within the organization.

Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics.

Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho's indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.

Twisted vortex Gaussian Schell-model beams.

We introduce a new class of partially coherent vortex beams in which the angular momentum of the beam is provided from two different sources: the underlying vortex of the random beam and the "twist" given to the ensemble of beams. The statistical and propagation properties of such beams are investigated, and their orbital angular momentum properties are analyzed. The combination of distinct orbital angular momentum sources allows unusual behaviors that were previously unobserved.

Glycaemic control and excess risk of ischaemic and haemorrhagic stroke in patients with type 1 diabetes: a cohort study of 33 453 patients.

OBJECTIVE: To estimate the excess risk of stroke in relation to glycaemic control in patients with type 1 diabetes. METHODS: In this prospective, matched cohort study, we identified patients with type 1 diabetes, aged ≥18 years, who were registered in the Swedish National Diabetes Register from 1998-2011 and five control subjects for each case from the general population, matched for age, sex and county of residence. The risks of all strokes, ischaemic stroke and haemorrhagic stroke were estimated using Cox hazard regression. RESULTS: Of 33 453 type 1 diabetes patients [mean age, 35.5 (SD 14.4) years; mean follow-up, 7.9 (SD 4.3) years; and mean diabetes duration, 20.2 years (SD 14.6)], 762 (2.3%) were diagnosed with stroke compared with 1122 (0.7%) of 159 924 control subjects [mean follow-up, 8.2 (SD 4.3) years]. The overall multiple-adjusted hazard ratios (HRs) for type 1 diabetes patients versus control subjects were 3.29 (95% CI: 2.96-3.66) and 2.49 (95% CI: 1.96-3.16) for ischaemic and haemorrhagic stroke, respectively. The risk of ischaemic and haemorrhagic stroke incrementally increased with increasing HbA1c; the risk of ischaemic stroke was significantly increased with HbA1c within target [≤6.9% (≤52 mmol mol-1 )] [multiple-adjusted HR 1.89 (95% CI: 1.44-2.47)]. For HbA1c ≥9.7% (≥83 mmol mol-1 ), there was a markedly increased risk of both ischaemic and haemorrhagic stroke, with multiple-adjusted HRs of 7.94 (95% CI: 6.29-10.03) and 8.17 (95% CI 5.00-13.35), respectively. CONCLUSIONS: Individuals with type 1 diabetes have an increased risk of ischaemic and haemorrhagic stroke, increasing markedly with poor glycaemic control.

Long-term excess risk of stroke in people with Type 2 diabetes in Sweden according to blood pressure level: a population-based case-control study.

AIMS: To estimate the risk of stroke in people with Type 2 diabetes with different blood pressure levels compared with the risk in the general population in Sweden. METHODS: This prospective case-control study included 408 076 people with Type 2 diabetes, aged ≥ 18 years, and free of prior stroke, registered in the Swedish National Diabetes Register 1998-2011. Age- and sex-matched control subjects (n = 1 913 507) without stroke from the general population were included. Stroke diagnoses were retrieved using International Classification of Disease codes from the Swedish patient and death registers. Cox hazard ratios and 95% confidence intervals (CIs) were estimated at six different blood pressure levels. RESULTS: During a median follow-up of 4 years, 19 548 (4.8%) people with Type 2 diabetes and 61 690 (3.2%) without diabetes were diagnosed with stroke, corresponding to an adjusted hazard ratio of 1.43 (95% CI 1.41-1.46) for people with Type 2 diabetes as a group. Compared with people without diabetes, the risk of stroke for people with Type 2 diabetes with different blood pressure levels was significantly higher, starting at blood pressure levels > 130/80 mmHg. Hazard ratios for stroke were 1.20 (95% CI 1.16-1.24), 1.47 (95% CI 1.43-1.50), and 1.97 (95% CI 1.90-2.03) for blood pressure categories of 130-139/80-89 mmHg, 140-159/90-99 mmHg and ≥ 160/≥ 100 mmHg, respectively, after adjustment for age, sex, diabetes duration, being born in Sweden, maximum education level and baseline comorbidities. CONCLUSIONS: People with Type 2 diabetes and blood pressure < 130/80 mmHg had a risk of stroke similar to that of the general population.

Partially coherent vortex beams of arbitrary order.

We derive analytic solutions for an infinite set of partially coherent vortex beams (PCVBs) of any azimuthal order and for any propagation distance. The correlation singularities of the beams and their orbital angular momentum are investigated. This detailed study of PCVBs opens the possibility of using such beams for remote sensing and free-space optical communications.

Determination of 'recruited volume' following a PEEP step is not a measure of lung recruitability.

BACKGROUND: It has been proposed that the analysis of positive end-expiratory pressure (PEEP)-induced volume changes can quantify alveolar recruitment. The potential of a lung to be recruited is expected to be high in acute respiratory distress syndrome (ARDS), where collapsed lung tissue is very common. The volume change that is beyond the delta volume because of the patient's compliance has been termed 'recruited volume' (RecV). However, data of patients with low and high RecV showed less severe lung disease in high 'recruiters', indicating that RecV may not equal the 'potentially recruitable lung tissue' seen in computed tomography scans. We hypothesized that RecV is higher in lung-healthy (LH) patients with little collapsed lung compared with ARDS patients. METHODS: RecV and inspiratory capacity (IC) were determined in 12 LH and in 25 ARDS patients during incremental PEEP (steps of 2 cmH2 O). RecV was determined as the time-dependent increase in end-expiratory volume following the first expiration to the new PEEP level (ΔTDV). Gas distribution in LH patients was analyzed by electric impedance tomography. RESULTS: Cumulative RecV(ΔTDV) and IC were higher (P < 0.01) in LH compared with ARDS patients, 1739 ml vs. 832 ml and 4432 ml vs. 2020 ml, respectively. In both groups, RecV correlated excellently with IC (R(2) = 0.86). In LH, RecV emanated mainly from nondependent lung regions at PEEP below 15 cmH2O. Maximum plateau pressure was reached with fewer PEEP steps in ARDS compared with LH patients (11 vs. 14, P < 0.01). CONCLUSION: Our findings suggest that RecV predominately measures a slow fraction of inflation of already aerated lung tissue and not recruitment of collapsed alveoli.

Complete representation of a correlation singularity in a partially coherent beam.

An understanding of phase singularities of correlation functions is important in optical coherence theory and imaging science, but to date such singularities have only been theoretically studied in a single transverse plane, at most. In this Letter we evaluate the complete structure of a correlation singularity of a partially coherent Laguerre-Gauss beam, describing it in both the transverse and the propagation directions. These results agree with previously found solutions, and introduce new aspects of correlation singularities.

Incidence of Type 2 diabetes among occupational classes in Sweden: a 35-year follow-up cohort study in middle-aged men.

AIMS: To assess if low occupational class was an independent predictor of Type 2 diabetes in men in Sweden over a 35-year follow-up, after adjustment for both conventional risk factors and psychological stress. METHODS: A random population-based sample of 6874 men aged 47-56 years without a history of diabetes was divided into five occupational classes and the men were followed from 1970 to 2008. Diabetes cases were identified through the Swedish inpatient and death registers. Subdistribution hazard ratios (SHRs) and 95% CIs from competing risk regressions, cumulative incidence and conditional probabilities were calculated, after accounting for the risk of death attributed to other causes. RESULTS: A total of 907 (13%) men with diabetes were identified over 35 years with a median follow-up of 27.9 years. The cumulative incidence of diabetes, when taking into account death as a competing event, was 11% in high officials, 12% in intermediate non-manual employees, 14% in assistant non-manual employees, 14% in skilled workers, and 16% in unskilled and semi-skilled workers. Men with unskilled and semi-skilled manual occupations had a significantly higher risk of diabetes than high officials (reference) after adjustment for age, BMI, hypertension, smoking and physical activity (SHR 1.39, 95% CI 1.08-1.78). Additional adjustment for self-reported psychological stress did not attenuate the results. CONCLUSIONS: A low occupational class suggests a greater risk of Type 2 diabetes, independently of conventional risk factors and psychological stress.

Disentangling common and specific neural subprocesses of response inhibition.

Response inhibition is disturbed in several disorders sharing impulse control deficits as a core symptom. Since response inhibition is a cognitively and neurally multifaceted function which has been shown to rely on differing neural subprocesses and neurotransmitter systems, further differentiation to define neurophysiological endophenotypes is essential. Response inhibition may involve at least three separable cognitive subcomponents, i.e. interference inhibition, action withholding, and action cancelation. Here, we introduce a novel paradigm - the Hybrid Response Inhibition task - to disentangle interference inhibition, action withholding and action cancelation and their neural subprocesses within one task setting during functional magnetic resonance imaging (fMRI). To validate the novel task, results were compared to a battery of separate, standard response inhibition tasks independently capturing these subcomponents and subprocesses. Across all subcomponents, mutual activation was present in the right inferior frontal cortex (rIFC), pre-supplementary motor area (pre-SMA) and parietal regions. Interference inhibition revealed stronger activation in pre-motor and parietal regions. Action cancelation resulted in stronger activation in fronto-striatal regions. Our results show that all subcomponents share a common neural network and thus all constitute different subprocesses of response inhibition. Subprocesses, however, differ to the degree of regional involvement: interference inhibition relies more pronouncedly on a fronto-parietal-pre-motor network suggesting its close relation to response selection processes. Action cancelation, in turn, is more strongly associated with the fronto-striatal pathway implicating it as a late subcomponent of response inhibition. The new paradigm reliably captures three putatively subsequent subprocesses of response inhibition and might be a promising tool to differentially assess disturbed neural networks in disorders showing impulse control deficits.

Perceived stress and incidence of Type 2 diabetes: a 35-year follow-up study of middle-aged Swedish men.

AIM: To explore incident cases of diagnosed diabetes over 35 years of follow-up in relation to self-perceived stress at baseline. METHODS: This was a population-based random sample of 7251 men derived from the Primary Prevention Trial Study, aged 47-56 years at baseline and without prior history of diabetes, coronary heart disease and stroke. Incident diabetes was identified from hospital discharge and death registries as principal or secondary diagnosis. Cox proportional hazards regression was used to evaluate the potential association between stress and diabetes. RESULTS: During a 35-year follow-up, a total of 899 men were identified with diabetes. The crude incidence was 5.2 per 1000 persons-years. At baseline, 15.5% men reported permanent stress related to conditions at work or home. After adjusting for age and competing risk of death, the estimated 35-year conditional probability of diabetes in men with permanent stress was 42.6%, compared with 31.0% for those with periodic stress and 31.2% with no stress. In age-adjusted Cox regression analysis, men with permanent stress had a higher risk of diabetes [hazard ratio 1.52 (95% CI 1.26-1.82)] compared with men with no (referent) or periodic stress [hazard ratio 1.09 (95% CI 0.94-1.27)]. The association between stress and diabetes was slightly attenuated but remained significant after adjustment for age, socio-economic status, physical inactivity, BMI, systolic blood pressure and use of anti-hypertensive medication [hazard ratio 1.45 (95% CI 1.20-1.75)]. When examining principal diagnosis of diabetes cases separately from secondary diagnoses cases, the excess risk of diabetes associated with permanent stress remained significant both in age (only) and multivariable adjusted models. CONCLUSION: Self-perceived permanent stress is an important long-term predictor of diagnosed diabetes, independently of socio-economic status, BMI and other conventional Type 2 diabetes risk factors.

Multi-disciplinary assessment of the entrustable professional activities of surgery residents.

Purpose: Medicine is practiced in a collaborative and interdisciplinary manner. However, medical training and assessment remain largely isolated in traditional departmental silos. Two Entrustable Professional Activities (EPAs) developed by the American Board of Surgery are multidisciplinary in nature and offer a unique opportunity to study interdisciplinary assessment. Methods: EPA microassessments were collected from Surgery and Emergency Medicine (EM) faculty between July 2018 and May 2020. Differences in feedback provided by faculty were assessed using natural language processing (NLP) techniques, (1) automated algorithms; and (2) topic modeling. Summative content analysis was used to identify themes in text feedback. We developed automated coding algorithms for these themes using regular expressions. Topic modeling was performed using latent Dirichlet allocation. Results: 549 assessments were collected for two EPAs: 198 for GS Consultation and 351 for Trauma. 27 EM and 27 Surgery faculty provided assessments for 71 residents. EM faculty were significantly more likely than Surgery faculty to submit feedback coded as Communication, Demeanor, and Timeliness, (all chi-square test p-values < 0.01). No significant differences were found for Clinical Performance, Skill Level, or Areas for Improvement. Similarly, topic modeling indicated that assessments submitted by EM faculty focused on communication, timeliness, and interpersonal skills, while those submitted by Surgery faculty focused on the residents' abilities to effectively gather information and correctly diagnose the underlying pathology. Conclusions: Feedback from EM and Surgery faculty differed significantly based on NLP analyses. EPA assessments should stem from multiple sources to avoid assessment gaps and represent a more holistic picture of performance.

[High risk pulmonary embolism. Case report of a successful embolectomy]. / Hochrisikolungenembolie. Fallbeschreibung einer erfolgreichen Embolektomie.

High risk pulmonary embolism commonly presents with a variety of symptoms and is an acute life-threatening event. In patients showing unclear acute circulatory distress, pulmonary embolism should be quickly ruled out by computed tomography or echocardiography. The diagnostic steps and surgical treatment of pulmonary embolism in a 25-year-old female patient suffering from acute circulatory insufficiency resulting in cardiac arrest within 11 min after emergency hospital admission are reported. Due to the reasonable suspicion of acute right heart decompensation, systemic perfusion was re-established by cardiopulmonary bypass after cardiopulmonary resuscitation for 41 min. Sternotomy and surgical embolectomy were performed. The patient was successfully extubated the following day and despite the long resuscitation time the outcome was excellent without any neurological deficit. Recent publications addressing the advantages of primary embolectomy versus intravenous thrombolysis in acute circulatory distress caused by pulmonary embolism are discussed. Primary surgical treatment including cardiopulmonary bypass for right ventricular relief and re-establishing of systemic perfusion is recommended for patients with pulmonary embolism undergoing cardiopulmonary resuscitation.

How Can Intranasal Oxytocin Research Be Trusted? A Systematic Review of the Interactive Effects of Intranasal Oxytocin on Psychosocial Outcomes.

Over the past two decades, research about the role of oxytocin (OT) in human behavior has grown exponentially. However, a unified theory of OT effects has yet to be developed. Relatedly, growing concerns about the robustness of conclusions drawn in the field have been raised. The current article contributes to this debate by reporting on and discussing key conclusions from a systematic review of published studies addressing the interactive effects of intranasal OT (IN-OT) administration on psychosocial outcomes in a healthy population. The review indicates that (a) tested interactive IN-OT effects were highly heterogeneous; (b) for most published interactions, no replication was attempted; (c) when attempted, replications were largely unsuccessful; (d) significance was unrelated to sample size; (e) statistical power was critically low and unrelated to the rate of significant results; and (f) research practices were characteristic of an exploratory approach. This concerning state of affairs makes it virtually impossible to tease apart true from false interactive IN-OT effects. We provide constructive directions on the basis of this observation and positive predictive value simulations for future research that should help extract true effects from noise and move the IN-OT field forward.

Growth performance, carcass characteristics, fresh belly quality, and commercial bacon slicing yields of growing-finishing pigs from sire lines intended for different industry applications.

The objective was to control intrinsic and extrinsic factors associated with the production and slaughter of pigs to determine effects of sire line (Pietrain vs. Duroc ancestry) on growth performance, carcass and belly characteristics, and commercial bacon yields of growing-finishing pigs. There were no differences in growth performance (P ≥ 0.08) or belly processing characteristics (P ≥ 0.09). Pietrain sired pigs had a greater lean yield (P ≤ 0.01). Duroc sired pigs had darker, more highly marbled loins (P ≤ 0.04) and thicker bellies (P < 0.001). Bacon from Pietrain sired pigs had a greater (P = 0.04) lean to fat ratio with 1.58% increase (P = 0.04) in average bacon slice lean. Barrows had more highly marbled loins (P ≤ 0.01) and thicker bellies (P < 0.001) than gilts. Bacon from barrows had a greater slice area (P < 0.001) while bacon from gilts had a greater lean to fat ratio (P = 0.04).

Electrical impedance tomography to confirm correct placement of double-lumen tube: a feasibility study.

BACKGROUND: Double-lumen tubes (DLTs) are frequently used to establish one-lung ventilation (OLV). Their correct placement is crucial. We hypothesized that electrical impedance tomography (EIT) reliably displays distribution of ventilation between left and right lung and may thus be used to verify correct DLT placement online. METHODS: Regional ventilation was studied by EIT in 40 patients requiring insertion of left-sided DLTs for OLV during thoracic surgery. EIT was recorded during two-lung ventilation before induction of anaesthesia and after DLT placement, and during OLV in the supine and subsequently in the lateral position. EIT measurements were made before and after verification of correct DLT placement by fibreoptic bronchoscopy (FOB). RESULTS: EIT accurately displayed distribution of ventilation between left and right lung online. All cases (n=5) of initially misplaced DLTs in the contralateral right main bronchus were detected by EIT. However, EIT did not allow prediction of FOB-detected endobronchial cuff misplacement requiring DLT repositioning. Furthermore, after DLT repositioning, distribution of ventilation, as assessed by EIT, did not change significantly (all P>0.5). CONCLUSIONS: This study demonstrates that EIT enables accurate display of left and right lung ventilation and, thus, non-invasive online recognition of misplacement of left-sided DLTs in the contralateral main bronchus. However, as distribution of ventilation did not correlate with endobronchial cuff placement, EIT cannot replace FOB in the routine control of DLT position.

The correlation of chemical and physical corn kernel traits with production performance in broiler chickens and laying hens.

A study was conducted to determine the influence on broiler chicken growth and laying hen performance of chemical and physical traits of corn kernels from different hybrids. A total of 720 male 1-d-old Ross-308 broiler chicks were allotted to floor pens in 2 replicated experiments with a randomized complete block design. A total of 240 fifty-two-week-old Hy-Line W-36 laying hens were allotted to cages in a randomized complete block design. Corn-soybean meal diets were formulated for 3 broiler growth phases and one 14-wk-long laying hen phase to be marginally deficient in Lys and TSAA to allow for the detection of differences or correlations attributable to corn kernel chemical or physical traits. The broiler chicken diets were also marginally deficient in Ca and nonphytate P. Within a phase, corn- and soybean-based diets containing equal amounts of 1 of 6 different corn hybrids were formulated. The corn hybrids were selected to vary widely in chemical and physical traits. Feed consumption and BW were recorded for broiler chickens every 2 wk from 0 to 6 wk of age. Egg production was recorded daily, and feed consumption and egg weights were recorded weekly for laying hens between 53 and 67 wk of age. Physical and chemical composition of kernels was correlated with performance measures by multivariate ANOVA. Chemical and physical kernel traits were weakly correlated with performance in broiler chickens from 0 to 2 wk of age (P<0.05, | r |<0.42). However, from 4 to 6 wk of age and 0 to 6 wk of age, only kernel chemical traits were correlated with broiler chicken performance (P<0.05, | r |<0.29). From 53 to 67 wk of age, correlations were observed between both kernel physical and chemical traits and laying hen performance (P<0.05, | r |<0.34). In both experiments, the correlations of performance measures with individual kernel chemical and physical traits for any single kernel trait were not large enough to base corn hybrid selection on for feeding poultry.

AUTOPILOT-BT: a system for knowledge and model based mechanical ventilation.

A closed-loop system (AUTOPILOT-BT) for the control of mechanical ventilation was designed to: 1) autonomously achieve goals specified by the clinician, 2) optimize the ventilator settings with respect to the underlying disease and 3) automatically adapt to the individual properties and specific disease status of the patient. The current realization focuses on arterial oxygen saturation (SpO(2)), end-tidal CO(2) pressure (P(et)CO(2)), and positive end-expiratory pressure (PEEP) maximizing respiratory system compliance (C(rs)). The "AUTOPILOT-BT" incorporates two different knowledge sources: a fuzzy logic control reflecting expert knowledge and a mathematical model based system that provides individualized patient specific information. A first evaluation test with respect to desired end-tidal-CO(2)-level was accomplished using an experimental setup to simulate three different metabolic CO(2) production rates by means of a physical lung simulator. The outcome of ventilator settings made by the "AUTOPILOT-BT" system was compared to those produced by clinicians. The model based control system proved to be superior to the clinicians as well as to a pure fuzzy logic based control with respect to precision and required settling time into the optimal ventilation state.

Alternative vaccination against equine botulism (BoNT/C).

REASON FOR PERFORMING STUDY: In Europe the incidence of botulism in horses has increased in the last decade due to the growing popularity of haylage feeding. Recombinant vaccines are safer and less expensive to produce and are generally better tolerated than toxoids. OBJECTIVES: To investigate whether the recombinant C-terminal half of the heavy chain of the botulinum neurotoxin C (Hc BoNT/C) in combination with an immunstimulatory adjuvant is an appropriate vaccine candidate for horses by testing its efficacy to induce neutralising antibodies and by comparing its immunogenic properties and adverse reactions to a commercial toxoid vaccine. Formation of oedema and local pain reactions were assessed. ELISA and Western blot assay against Hc BoNT/C and testing of neutralising antibody induction in a mouse protection assay were used to evaluate the immune response. RESULTS: With the recombinant vaccine, only minor local swelling with full recovery after 5 days was noted after brisket injections. The toxoid vaccine produced local, painful reactions with longer recovery periods of up to 2 weeks. Horses vaccinated with either vaccine induced neutralising antibodies after the second booster vaccination, while seroconversion on ELISA and Western blot to Hc BoNT/C was apparent after the first recombinant vaccination, and at various time points in the vaccination schedule in horses that received commercial toxoid vaccine. CONCLUSION: The recombinant vaccine showed fewer adverse reactions compared to the only commercially available vaccine but induced similar concentrations of neutralising antibodies. There was no correlation between the serological response to Hc BoNT/C and the neutralising capacity of serum. POTENTIAL RELEVANCE: Recombinant Hc BoNT/C is an appropriate vaccine candidate to stimulate production of neutralising antibodies against botulinum neurotoxin C in horses and creates only minor local reactions at the injection site.