Improving the mental health of farmers: what types of remote support are acceptable, feasible, and improve outcomes? A feasibility RCT

BACKGROUND

The farming community have high rates of poor mental health, and are relatively 'hard to reach' with mental health services. The aim of this study was therefore to undertake a feasibility RCT, based on two mental health interventions. These were (1) CBT based 'Living Life to the Full for Farming Communities' (LLTTF-F; www.llttf.com ), and (2) a holistic social and emotional support service delivered by the Royal Scottish Agricultural Benevolent Institution (RSABI). The feasibility was supplemented by process evaluation.

METHODS

This feasibility study aimed to recruit 40 individuals from the farming community who were experiencing a common health problem defined as a score of >  = 8 on PHQ-9. A snowball approach was used to recruit interested individuals who had an association with farming. An initial telephone call screened for eligibility and obtained consent to randomisation to the two specified interventions, or to a thirdly group receiving a combination of both LLTTF-F and 'Social and emotional support'. Participants were permitted to override the randomised option if they expressed a strong preference before the interventions began.

RESULTS

Thirty-two participants provided baseline and three-month data. All three interventions showed positive improvements on PHQ-9 scores as follows: the 'combined intervention' mean baseline score was 18.1 compared to 12.0 at 3-month follow-up (mean change 6.1). 'Social and emotional support' mean baseline score was 11.3 compared to 6.7 at 3-month follow-up (mean change 4.6). 'LLTTF-F CBT-based intervention only' mean baseline score was 11.8 compared to 4.5 at 3-month follow-up (mean change 7.3). The retention rate was 81% at three months. In a sub-group of the LLTTF-F CBT-based intervention online materials were supplemented by telephone guided support. This approach received very positive feedback.

CONCLUSIONS

Recruitment from the farming community required intense effort, and good engagement can then be retained for at least three months. There is evidence that the interventions used were feasible, and tentative evidence that they had a demonstrable effect on mental wellbeing, with the LLTTFF providing the largest effect on PHQ-9 scores. Trial Registration Number ISRCTN27173711, submitted 25/08/2023, confirmed 22/092023.

Bacteriological Survey of Fresh Minced Beef on Sale at Retail Outlets in Scotland in 2019: Three Foodborne Pathogens, Hygiene Process Indicators, and Phenotypic Antimicrobial Resistance

ABSTRACT

The health and economic burden of foodborne illness is high, with approximately 2.4 million cases occurring annually in the United Kingdom. A survey to understand the baseline microbial quality and prevalence of food-related hazards of fresh beef mince on retail sale could inform risk assessment, management, and communication to ensure the safety of this commodity. In such a survey, a two-stage sampling design was used to reflect variations in population density and the market share of five categories of retail outlets in Scotland. From January to December 2019, 1,009 fresh minced beef samples were collected from 15 geographic areas. The microbial quality of each sample was assessed using aerobic colony count and Escherichia coli count. Samples were cultured for Campylobacter and Salmonella, and PCR was used to detect target genes (stx1 all variants, stx2 a to g, and rfbO157) for Shiga toxin-producing E. coli (STEC). The presence of viable E. coli O157 and STEC in samples with a positive PCR signal was confirmed via culture and isolation. Phenotypic antimicrobial sensitivity patterns of cultured pathogens and 100 E. coli isolates were determined, mostly via disk diffusion. The median aerobic colony count and E. coli counts were 6.4 × 105 (interquartile range, 6.9 × 104 to 9.6 × 106) and <10 CFU/g (interquartile range, <10 to 10) of minced beef, respectively. The prevalence was 0.1% (95% confidence interval [CI], 0 to 0.7%) for Campylobacter, 0.3% (95% CI, 0 to 1%) for Salmonella, 22% (95% CI, 20 to 25%) for PCR-positive STEC, and 4% (95% CI, 2 to 5%) for culture-positive STEC. The evidence for phenotypic antimicrobial resistance detected did not give cause for concern, mainly occurring in a few E. coli isolates as single nonsusceptibilities to first-line active substances. The low prevalence of pathogens and phenotypic antimicrobial resistance is encouraging, but ongoing consumer food safety education is necessary to mitigate the residual public health risk.

HIGHLIGHTS

The mental health of NHS staff during the COVID-19 pandemic: two-wave Scottish cohort study

BACKGROUND

Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath.

AIMS

A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time.

METHOD

A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later.

RESULTS

The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time.

CONCLUSIONS

HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic.

The British E. coli O157 in cattle study (BECS): factors associated with the occurrence of E. coli O157 from contemporaneous cross-sectional surveys

BACKGROUND

Escherichia coli O157 is a bacterial pathogen associated with severe disease in humans for which cattle are an important reservoir of infection. The identification of possible risk factors for infection in cattle could facilitate the development of control strategies and interventions to mitigate the risk to human health. The purpose of this study was to utilize data collected in 2014-2015 during the two contemporaneous cross-sectional surveys of the British E. coli O157 in Cattle Study (BECS) to investigate potential risk factors for E. coli O157 status in cattle destined for the food chain.

RESULTS

In the England & Wales survey only one variable, herd size, was associated with the outcome farm-level E. coli O157 positive status. The odds increased for each additional animal in the herd. In the Scotland survey, as well as a measure of herd size (the number of cattle aged 12-30 months), having brought breeding females on to the farm in the last year also increased the odds, whereas farms sampled in spring were less likely to be positive compared to those sampled in autumn. On the positive farms, in both surveys, an increase in the proportion of pats positive for E. coli O157 was associated with animals being housed at the time of sampling. However, the effect of housing on pat-level prevalence within positive groups was lower on farms from England & Wales than from Scotland (OR 0.45 (95% C.I. 0.24-0.86)).

CONCLUSION

For the first time, factors associated with farm-level E. coli O157 status have been investigated in two contemporaneous surveys with comparable study design. Although factors associated with farm-level E. coli O157 status differed between the two surveys, one consistent factor was an association with a measure of herd size. Factors associated with the proportion of E. coli O157 positive pats within a positive farm were similar in both surveys but differed from those associated with farm-level status. These findings raise the hypothesis that measures to protect public health by reducing the risk from cattle may need to be tailored, rather than by assuming that a GB-wide protocol is the best approach.

Difficulties arising from the variety of testing schemes used for bovine viral diarrhoea virus (BVDV)

Globally, the eradication of bovine viral diarrhoea virus (BVDV) is still in its infancy, but eradication has been, or is being, adopted by several countries or regions. Comparisons between countries' schemes allow others to assess best practice, and aggregating published results from eradication schemes provides greater statistical power when analysing data. Aggregating data requires that results derived from different testing schemes be calibrated against one another. The authors aimed to evaluate whether relationships between published BVDV test results could be created and present the outcome of a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results are tabulated, providing a summary of papers where there is potential cross-calibration and a summary of the obstacles preventing such data aggregation. Although differences in measuring BVDV present barriers to academic progress, they may also affect progress within individual eradication schemes. The authors examined the time taken to retest following an initial antibody BVDV test in the Scottish eradication scheme. The authors demonstrate that retesting occurred quicker if the initial not negative test was from blood rather than milk samples. Such differences in the response of farmers/veterinarians to tests may be of interest to the design of future schemes.

Not all cows are epidemiologically equal: quantifying the risks of bovine viral diarrhoea virus (BVDV) transmission through cattle movements

Many economically important cattle diseases spread between herds through livestock movements. Traditionally, most transmission models have assumed that all purchased cattle carry the same risk of generating outbreaks in the destination herd. Using data on bovine viral diarrhoea virus (BVDV) in Scotland as a case example, this study provides empirical and theoretical evidence that the risk of disease transmission varies substantially based on the animal and herd demographic characteristics at the time of purchase. Multivariable logistic regression analysis revealed that purchasing pregnant heifers and open cows sold with a calf at foot were associated with an increased risk of beef herds being seropositive for BVDV. Based on the results from a dynamic within-herd simulation model, these findings may be partly explained by the age-related probability of animals being persistently infected with BVDV as well as the herd demographic structure at the time of animal introductions. There was also evidence that an epidemiologically important network statistic, "betweenness centrality" (a measure frequently associated with the potential for herds to acquire and transmit disease), was significantly higher for herds that supplied these particular types of replacement beef cattle. The trends for dairy herds were not as clear, although there was some evidence that open heifers and open lactating cows were associated with an increased risk of BVDV. Overall, these findings have important implications for developing simulation models that more accurately reflect the industry-level transmission dynamics of infectious cattle diseases.

Replicating disease spread in empirical cattle networks by adjusting the probability of infection in random networks

Comparisons between mass-action or "random" network models and empirical networks have produced mixed results. Here we seek to discover whether a simulated disease spread through randomly constructed networks can be coerced to model the spread in empirical networks by altering a single disease parameter - the probability of infection. A stochastic model for disease spread through herds of cattle is utilised to model the passage of an SEIR (susceptible-latent-infected-resistant) through five networks. The first network is an empirical network of recorded contacts, from four datasets available, and the other four networks are constructed from randomly distributed contacts based on increasing amounts of information from the recorded network. A numerical study on adjusting the value of the probability of infection was conducted for the four random network models. We found that relative percentage reductions in the probability of infection, between 5.6% and 39.4% in the random network models, produced results that most closely mirrored the results from the empirical contact networks. In all cases tested, to reduce the differences between the two models, required a reduction in the probability of infection in the random network.

Changes in cardiovascular risk factors in relation to increasing ethnic inequalities in cardiovascular mortality: comparison of cross-sectional data in the Health Surveys for England 1999 and 2004

OBJECTIVES

Reducing disease inequalities requires risk factors to decline quickest in the most disadvantaged populations. Our objective was to assess whether this happened across the UK's ethnic groups.

DESIGN

Secondary analysis of repeated but independent cross-sectional studies focusing on Health Surveys for England 1999 and 2004.

SETTING

Community-based population level surveys in England.

PARTICIPANTS

Seven populations from the major ethnic groups in England (2004 sample sizes): predominantly White general (6704), Irish (1153), Chinese (723), Indian (1184), Pakistani (941), Bangladeshi (899) and Black Caribbean (1067) populations. The numbers were smaller for specific variables, especially blood tests.

OUTCOME MEASURES

Data on 10 established cardiovascular risk factors were extracted from published reports. Differences between 1999 and 2004 were defined a priori as occurring when the 95% CI excluded 0 (for prevalence differences), or 1 (for risk ratios) or when there was a 5% or more change (independent of CIs).

RESULTS

Generally, there were reductions in smoking and blood pressure and increases in the waist-hip ratio, body mass index and diabetes. Changes between 1999 and 2004 indicated inconsistent progress and increasing inequalities. For example, total cholesterol increased in Pakistani (0.3 mmol/L) and Bangladeshi men (0.3 mmol/L), and in Pakistani (0.3 mmol/L), Bangladeshi (0.4 mmol/L) and Black Caribbean women (0.3 mmol/L). Increases in absolute risk factor levels were common, for example, in Pakistani (five risk factors), Bangladeshi (four factors) and general population women (four factors). For men, Black Caribbeans had the most (five factor) increases. The changes relative to the general population were also adverse for three risk factors in Pakistani and Black Caribbean men, four in Bangladeshi women and three in Pakistani women.

CONCLUSIONS

Changes in populations with the most cardiovascular disease and diabetes did not decline the quickest. Cardiovascular screening programmes need more targeting.

Relative associations of cattle movements, local spread, and biosecurity with bovine viral diarrhoea virus (BVDV) seropositivity in beef and dairy herds

The success of bovine viral diarrhoea virus (BVDV) eradication campaigns can be undermined by spread through local transmission pathways and poor farmer compliance with biosecurity recommendations. This work combines recent survey data with cattle movement data to explore the issues likely to impact on the success of BVDV control in Scotland. In this analysis, data from 249 beef suckler herds and 185 dairy herds in Scotland were studied retrospectively to determine the relative influence of cattle movements, local spread, and biosecurity on BVDV seropositivity. Multivariable logistic regression models revealed that cattle movement risk factors had approximately 3 times greater explanatory power than risk factors for local spread amongst beef suckler herds, but approximately the same explanatory power as risk factors for local spread amongst dairy herds. These findings are most likely related to differences in cattle husbandry practices and suggest that where financial prioritization is required, focusing on reducing movement-based risk is likely to be of greatest benefit when applied to beef suckler herds. The reported use of biosecurity measures such as purchasing cattle from BVDV accredited herds only, performing diagnostic screening at the time of sale, implementing isolation periods for purchased cattle, and installing double fencing on shared field boundaries had minimal impact on the risk of beef or dairy herds being seropositive for BVDV. Only 28% of beef farmers and 24% of dairy farmers with seropositive herds recognized that their cattle were affected by BVDV and those that did perceive a problem were no less likely to sell animals as replacement breeding stock and no more likely to implement biosecurity measures against local spread than farmers with no perceived problems. In relation to the current legislative framework for BVDV control in Scotland, these findings emphasize the importance of requiring infected herds take appropriate biosecurity measures to prevent further disease transmission and conducting adequate follow-up to ensure that biosecurity measures are being implemented correctly in the field.

Does circumpatellar electrocautery improve the outcome after total knee replacement?: a prospective, randomised, blinded controlled trial

The incidence of anterior knee pain following total knee replacement (TKR) is reported to be as high as 49%. The source of the pain is poorly understood but the soft tissues around the patella have been implicated. In theory circumferential electrocautery denervates the patella thereby reducing efferent pain signals. However, there is mixed evidence that this practice translates into improved outcomes. We aimed to investigate the clinical effect of intra-operative circumpatellar electrocautery in patients undergoing TKR using the LCS mobile bearing or Kinemax fixed bearing TKR. A total of 200 patients were randomised to receive either circumpatellar electrocautery (diathermy) or not (control). Patients were assessed by visual analogue scale (VAS) for anterior knee pain and Oxford knee score (OKS) pre-operatively and three months, six months and one year post-operatively. Patients and assessors were blinded. There were 91 patients in the diathermy group and 94 in the control. The mean VAS improvement at one year was 3.9 in both groups (control; -10 to 6, diathermy; -9 to 8, p < 0.001 in both cases, paired, two-tailed t-test). There was no significant difference in VAS between the groups at any other time. The mean OKS improvement was 17.7 points (0 to 34) in the intervention group and 16.6 (0 to 42) points in the control (p = 0.36). There was no significant difference between the two groups in OKS at any other time. We found no relevant effect of patellar electrocautery on either VAS anterior knee pain or OKS for patients undergoing LCS and Kinemax TKR.

Prevalence of antibodies to bovine viral diarrhoea virus in bulk tank milk and associated risk factors in Scottish dairy herds

Bulk tank milk samples were collected from 374 dairy farms in Scotland in 2007/2008 along with questionnaire data relating to the management of the farm. Milk samples were tested for antibodies to bovine viral diarrhoea virus (BVDV) using a commercially available (Svanova) kit and percentage positivity scores calculated according to the manufacturer's guidelines. There were 220 farms that did not routinely vaccinate for bovine viral diarrhoea (BVD), and these were distributed according to the Swedish BVD eradication classes as 12.7 per cent, 22.3 per cent, 44.5 per cent and 20.5 per cent for Classes 0, 1, 2 and 3, respectively. A more sophisticated statistical method (finite mixture modelling) which does not depend on arbitrary thresholds and categories suggested a 73 per cent prevalence of herds with high mean levels of antibodies. Risk factor analysis suggested that routine vaccination for BVD, suspicion of BVD, housing of pregnant cows with calves, total number of cows and the proportion of cows that were dry were all associated with increased BVDV antibodies in bulk milk. The inclusion of BVD within the farm's health plan was associated with decreased BVDV antibodies in the bulk milk.

Predicted costs and benefits of eradicating BVDV from Ireland

Bovine viral diarrhoea virus (BVDV) causes an economically important endemic disease (BVD) of cattle in Ireland and worldwide. Systematic eradication by detection and removal of infectious (BVDV carrier) cattle has been successful in several regions. We therefore assessed the benefits (disease losses avoided) and costs (testing and culling regime) of a potential eradication programme in Ireland. Published bio-economic models of BVDV spread in beef suckler herds and dairy herds were adapted to estimate potential benefits of eradication in Ireland. A simple model of BVDV spread in beef finisher herds was devised to estimate the benefits of eradication in this sector. A six year eradication programme consisting of 5 inter-related virological and serological testing programmes is outlined and costed. We found that the annualised benefits of BVDV eradication in Ireland exceeded the costs by a factor of 5 in the beef suckler sector and a factor of 14 in the dairy sector. Corresponding payback periods were 1.2 and 0.5 years respectively. These results highlight the significant economic impact of BVDV on the Irish cattle industry and suggest a clear economic benefit to eradication using the proposed approach. This type of cost-benefit analysis is considered an essential prerequisite prior to undertaking an eradication campaign of this magnitude.

The influence of empirical contact networks on modelling diseases in cattle

We present two stochastic models of the passage of an SEIR (susceptible-latent-infected-resistant) disease through herds of cattle. One model is based on a contact network constructed via continuously recorded interaction data from two herds of cattle, the other, a matching network constructed using the principles of mass-action mixing. The recorded contact data were produced by attaching proximity data loggers to two separate herds of cattle during two separate recording periods. The network constructed using the principles of mass-action mixing uses the same number of contacts as the recorded network but distributes them randomly amongst the animals. The recorded networks had a greater number of repeated contacts, lower closeness and clustering scores and greater average path length than the mass-action networks. A lower proportion of simulations of the recorded network produce any disease spread when compared to those simulations of the mass-action network and, of those that did, fewer infected animals were predicted. For all parameter values tested, within the sensitivity analysis, similar differences were found between the recorded and mass-action network models.

A model of the relationship between the epidemiology of Johne’s disease and the environment in suckler-beef herds

A non-predictive, dynamic and stochastic herd-level simulation model of an outbreak of Johne's in a suckler-beef herd is reported. Importantly, the model incorporates, with a simple method, the environment as the primary source of infection, reflecting the consensual understanding of the disease. The model also takes into account the density of the infectious agent in the environment. A sensitivity analysis suggests that the model is highly and equally sensitive to certain parameters (probability of infection in the presence of one unit of bacterial density, infectious area and bacterial shedding rate). Mathematical reasons for this similarity in sensitivity are presented. Compared to many other diseases, data for Johne's are scarce. Therefore models of Johne's outbreaks including this one cannot be predictive or easily validated. The qualitative results: (a) demonstrate the modelled effect of inclusion of infection via the environment; (b) suggest management factors that could be tested by experimentation or observation. Estimates for the rate of transmission, arising from the model output, are similar to published empirical estimates. The results of future empirical research should aid scientific understanding of the disease, help validate this model and might bring economic benefits through improved management.

Changes in Scottish suicide rates during the Second World War

Background

It is believed that total reported suicide rates tend to decrease during wartime. However, analysis of suicide rates during recent conflicts suggests a more complex picture, with increases in some age groups and changes in method choice. As few age and gender specific analyses of more distant conflicts have been conducted, it is not clear if these findings reflect a change in the epidemiology of suicide in wartime. Therefore, we examined suicide rates in Scotland before, during and after the Second World War to see if similar features were present.

Methods

Data on deaths in Scotland recorded as suicide during the period 1931 – 1952, and population estimates for each of these years, were obtained from the General Register Office for Scotland. Using computer spreadsheets, suicide rates by gender, age and method were calculated. Forward stepwise logistic regression was used to assess the effect of gender, war and year on suicide rates using SAS V8.2.

Results

The all-age suicide rate among both men and women declined during the period studied. However, when this long-term decline is taken into account, the likelihood of suicide during the Second World War was higher than during both the pre-War and post-War periods. Suicide rates among men aged 15–24 years rose during the Second World War, peaking at 148 per million (41 deaths) during 1942 before declining to 39 per million (10 deaths) by 1945, while the rate among men aged 25–34 years reached 199 per million (43 deaths) during 1943 before falling to 66 per million (23 deaths) by 1946. This was accompanied by an increase in male suicides attributable to firearms and explosives during the War years which decreased following its conclusion.

Conclusion

All age male and female suicide rates decreased in Scotland during World War II. However, once the general background decrease in suicide rates over the whole period is accounted for, the likelihood of suicide among the entire Scottish population during the Second World War was elevated. The overall decrease in suicide rates concealed large increases in younger male age groups during the War years, and an increase in male suicides recorded as due to the use of firearms. We conclude that the effects of war on younger people, reported in recent conflicts in Central Europe, were also seen in Scotland during the Second World War. The results support the findings of studies of recent conflicts which have found a heterogeneous picture with respect to age specific suicide rates during wartime.

Modelling BVD at herd level compared with individual animal level

We assess two closely related stochastic models of BVD in a beef herd for their utility. One is an individual (animal) based model and the other a herd based model.

Optimal risk management versus willingness to pay for BVDV control options

Previous work has shown that the least-cost BVD-control option for cow-calf herds in Scotland was not necessarily the risk-minimising option. Thus, assessing BVDV prevention measures must account for risk reduction as well as decision-makers' attitude towards risks. We therefore describe a method to do this using a hypothetical example. Data for this analysis were generated using a simulation model of BVDV transmission in a typical Scottish cow-calf herd over a 10-year period. Herd infection/re-infection was adjusted to reflect the expected risk of infection/re-infection and the use of either biosecurity or vaccination strategies at various levels of effectiveness. The level of risk-free financial return that maximises farmers' utility of wealth was significantly affected by the assumed effectiveness of the control strategy. More importantly, it was observed that utility maximisation of wealth as a business objective is not an optimal solution in terms of animal welfare when dealing with a BVDV outbreak.

Assessing economic and social pressure for the control of bovine viral diarrhoea virus

The objective of this paper is to present a preliminary assessment of variation in the economic impact of bovine viral diarrhoea virus (BVDV) at dairy farm level between a sample of nations within the EU and hence assess differences in pressure to respond to this disease that may be impeding progress in control and hence restricting collective benefits from healthier livestock. We used a questionnaire to obtain national average values of key epidemiological and economic parameters for a typical dairy farm from BVDV experts in the countries concerned. These parameters were converted into assessments of economic impact using a computer simulation model. Uncontrolled output losses for a BVDV-naïve herd with virus introduced in year 1 of a 10-year epidemic represented 22, 7, 8, 5, 8 and 20% of the BVDV-free annuity for the UK, Northern Portugal, Holland, Norway, Italy and Germany, respectively. Differences between countries will be widened by differences in the risk of acquiring BVDV. These will be much reduced in countries, such as Norway that have a national BVDV eradication programme. Farmers in such countries can therefore justify spending much less on maintaining BVDV-free status than BVDV-free farms in other countries. This result illustrates the paradox that in countries where BVDV prevalence is high, farmers have least to gain from unilateral BVDV eradication because of the high cost of maintaining freedom from the disease. We discuss this issue in the light of increasing recognition at international level of the importance of BVDV control.

Financial incentive to control paratuberculosis (Johne's disease) on dairy farms in the United Kingdom

This paper estimates the financial incentive to control paratuberculosis on dairy farms by establishing the level of expenditure that would minimise the total cost of the disease (output losses plus control expenditure). Given the late onset of the clinical signs and the lack of treatments, control was focused on minimising the financial impact of paratuberculosis by adjusting the dairy cow replacement policy. The optimum replacement policies for disease-free herds and infected herds were compared by using dynamic programming. At the standard settings, the disease justified adjusting the culling policy; under constant bioeconomic assumptions, it reduced the expected annuity from milk production under the optimal replacement policy by about 10 per cent (27 pounds sterling per cow annually), a considerably lower figure than for other major endemic diseases that affect dairy cows in the uk. The effect was even less at lower milk prices, suggesting that there is at present little incentive for dairy farmers to put more resources into controlling the disease. However, the incentive could be increased if more information were available about how best to manage the disease under specific farm circumstances. Any effect that paratuberculosis may have on the future demand for milk and hence on milk prices would also be an important consideration.

A practical approach to calculate sample size for herd prevalence surveys

When designing a herd-level prevalence study that will use an imperfect diagnostic test, it is necessary to consider the test sensitivity and specificity. A new approach was developed to take into account the imperfections of the test. We present an adapted formula that, when combined with an existing piece of software, allows improved planning. Bovine paratuberculosis is included as an example infection because it originally stimulated the work. Examples are provided of the trade-off between the benefit (low number of herds) and the disadvantage (large number of animals per herd and exclusion of small herds) that are associated with achieving high herd-level sensitivity and specificity. We demonstrate the bias in the estimate of prevalence and the underestimate of the confidence range that would arise if we did not account for test sensitivity and specificity.

Modelling and costing BVD outbreaks in beef herds

Results from an epidemiological model of an outbreak of Bovine Viral Diarrhoea (BVD) within a Scottish beef suckler herd are presented. These results concurred with field observations and encouraged us to fulfill the objective of providing an estimate of losses due to BVD to assist decision makers. Using the output from the model, estimates were made of losses associated with the outbreak. Without taking into account any financial premiums associated with disease-free status, the estimate of pound 37 (58) mean loss per cow per annum suggests that health schemes and vaccination should be of immediate financial interest to farmers and veterinary advisors.

Influence of tetracycline exposure on tetracycline resistance and the carriage of tetracycline resistance genes within commensal Escherichia coli populations

AIMS

To assess the influence of incremental tetracycline exposure on the genetic basis of tetracycline resistance within faecal Escherichia coli.

METHODS AND RESULTS

Through the adoption of a novel combination of multiple breakpoint selection, phenotypic characterization and the application of a polymerase chain reaction based gene identification system it proved possible to monitor the influence of antibiotic exposure on resistance gene possession. Using tetracycline as a case study a clear hierarchy was revealed between tet genes, strongly influenced by host antimicrobial exposure history.

CONCLUSIONS

The antimicrobial exposure regime under which an animal is produced affects both the identity and magnitude of resistance gene possession of a selected bacterial population within its enteric microflora. Among the ramifications associated with such resistance gene selection is the degree of resistance conferred and the carriage of linked resistance determinants. This selection is applied by exposure to antibiotic concentrations well below recognized minimum inhibitory tetracycline concentration breakpoints widely adopted to characterize bacterial 'susceptibility'.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study confirms the ability of minimal antibiotic exposure to select for the continued persistence of resistance genes within the enteric microflora. It is clearly demonstrated that different antimicrobial regimes select for different resistance genes, the implications of which are discussed.

A linear programming approach to estimate the economic impact of bovine viral diarrhoea (BVD) at the whole-farm level in Scotland

We combined epidemiological and economic concepts and modelling techniques, to integrate animal health into whole-farm business management. This allowed us to assess the relative contribution that disease prevention could make to whole-farm income and to the variability in farm income (risk). It also allowed us to assess disease losses in the context of a farm business rather than as a disease outbreak in isolation. A linear program ("MOTAD") establishes the combination of decision maker's activities that minimise risk for a given level of income within farm-business constraints. The MOTAD model was applied to farm-management decision making in Scottish cow-calf herds and was linked to an epidemiological model of bovine viral diarrhoea (BVD). When BVD was considered in isolation (i.e. without taking into account risk), the minimum expected total cost of BVD (sum of output losses plus expenditure on prevention) was similar whether the herd was susceptible to BVD or of unknown BVD-status at the outset. However, the expected total cost of BVD fell in response to increasing expenditure on prevention in 'susceptible' herds. This relationship was not apparent in herds of unknown BVD-status. As a consequence of this difference, 'susceptible' herds were better able to use investment in BVD biosecurity as a means to increase farm income at minimum risk than herds of unknown BVD-status. 'Susceptible' herds therefore were able to achieve high income targets with less-intensive production than herds of unknown BVD-status. This suggested that maintaining a cow-calf herd free of BVD contributes to farm income and risk management indirectly through its effect on the management of the whole farm. It follows that measurement of the economic impact of BVD requires a whole-farm perspective that includes a consideration of risk. Because farmers generally are considered to be risk adverse, this means that the least-cost disease-control option might not always be the preferred option.

The quantitative measurement of antimicrobial resistance in Escherichia coli at the meta-population level (meta-population analysis)

AIMS

To define a method that describes antimicrobial resistance of meta-populations of bacteria in both a quantitative and biologically meaningful way.

METHODS AND RESULTS

Using spiral plating and colony counting technology we obtained, from animal faecal samples, the density of Escherichia coli that grow at different concentrations of antibiotic. A mathematical description of this dose-response curve fitted the data well. The parameters of this model have biological meaning and the model allowed subtle differences between meta-populations to be detected.

CONCLUSIONS

This method, termed MPA (meta-population analysis), is practical and provides a useful quantitative description of antimicrobial resistance in a bacterial meta-population.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study shows that resistance can be defined quantitatively. The method may be used in many epidemiological and clinical studies of antimicrobial resistance in animals and humans.