Effectiveness of patient education for patients with osteoporosis: a systematic review

In this systematic review, the effects of osteoporosis patient education were examined. All studies found an effect on physical function, but for the other themes, the results were inconclusive. The findings indicate a need for further research in this topic.

INTRODUCTION

Osteoporosis is a chronic disease with serious consequences for the individual and major societal costs. With the aim of fracture prevention, many countries offer osteoporosis patient education. The objectives were to examine the effects and mediators of osteoporosis patient education and describe the characteristics of studies with and without an effect. Though, none of the included studies reported mediators, and therefore, we could not examine that.

METHODS

Six databases were searched in October 2020. Two researchers independently conducted title and abstract screening as well as full-text review. Records were included if participants had osteoporosis, and the patient education was group-based, face-to-face, and addressed two or more aspects, e.g., diet, medication, and exercise. The Cochrane Collaboration tools were used for risk of bias assessment. Finally, data were extracted into a standardized form and presented narratively.

RESULTS

In total, 2934 records were identified, and 13 studies met the inclusion criteria. All six studies examining the effects of patient education on physical function demonstrated improvements. In addition, one out of two RCT studies and one non-randomized study reported improved psychological wellbeing. Just one out of five RCT studies showed improvements regarding physical discomfort and disability. Effects on health-related quality of life, adherence and persistence, and knowledge of osteoporosis were inconclusive.

CONCLUSION

There is limited evidence for the effectiveness of osteoporosis patient education. There is a need for high-quality randomized controlled trials, which should describe the characteristics of the interventions and examine the mechanisms of osteoporosis patient education.

PROSPERO REGISTRATION NUMBER

CRD42020211930.

Cardiac rehabilitation for patients with heart failure: a national Danish register-based study of predictors of referral and outcomes

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

 Heart failure (HF) places a large burden on patients and society as a major cause of morbidity, mortality and healthcare costs. Participation in exercise-based cardiac rehabilitation (CR) in people with HF is a clinically and cost-effective strategy and recommended in international clinical guidelines.

Purpose

The aims of this study were to: (1) examine the temporal trends and predictors of national CR referral, and (2) compare the risk of hospital readmission and mortality in those referred for CR compared to no referral.

Methods

All patients in Denmark with incident HF were identified by the Danish Heart Failure Register in the period 2010 to 2018 (n = 33,257) and CR referral assessed within 120 days of hospital admission. Multivariable logistic regression models were used to evaluate the association between CR referral and predictors and to compare risk of hospital readmission and mortality until 1 year between referred and not referred patients.

Results

Overall, 45.0% of HF patients were referred to exercise-based CR, increasing from 31.7% in 2010 to 52.2% in 2018. Factors independently associated with higher CR referral were: NYHA functional class II, LVEF <50%, diagnosis of myocardial infarction and use of ACE inhibitor. Male gender, older age, region, unemployment, retirement, living alone, non-Danish ethnic origin, lower educational level, NYHA class IV, treatment for hypertension, existing chronic obstructive lung disease and stroke were associated with lower CR referral. CR referral was associated with lower risk of readmission (adjusted odds ratio: 0.90;95%CI: 0.85-0.95), HF-specific mortality (0.61; 0.39-0.95) and all-cause mortality (0.61; 0.55-0.69) as compared to no referral.

Conclusions

Although CR referral has increased over time, only some 1 in 2 diagnosed HF patients in Denmark are referred to exercise-based CR. CR referral is associated with lower risk in readmissions and mortality. Strategies to promote CR referral including healthcare professional education on the benefits of CR and alternative methods of CR delivery are urgently needed to improve access to CR, especially for high-risk groups.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data.

Purpose

To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD.

Methods

This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega.

Results

Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67).

Conclusion

Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class.

Abstract Figure. Figre: Multiple adjusted analyses

Effectiveness of internet-based cognitive behavioural therapy for binge eating disorder

Introduction

Binge eating disorder (BED) is the most prevalent specific eating disorder. It is characterized by recurrent episodes of binge eating and is associated with feelings of shame and a lack of control. Internet-based treatments are gaining increasing attention as a way to reach more patients with evidence based treatments In 2020 we conducted a preliminary analysis on the effectiveness of an internet-based cognitive behavioural therapy treatment project (Jensen ES, Linnet, J, Holmberg TT, Tarp K, Nielsen JH, Lichtenstein MB. Effectiveness of internet-based guided self-help for binge-eating disorder and characteristics of completers versus noncompleters. Int J Eat Disord. 2020;1-6. https://doi.org/10.1002/eat.23384).

Objectives

This study aims to update the analyses on treatment effect with the patients who have completed treatment in the year following the last data extraction.

Methods

The iBED treatment project is a 10-session psychologist guided internet-based self-help program based on cognitive behavioural therapy. When applying for treatment and upon completion patients respond to a survey containing, among other scales, the eating disorder examination-questionnaire (EDE-Q), binge eating disorder-questionnaire (BED-Q) and various sociodemographic questions. Data will be extracted from the treatment project in anonymized form for analyses.

Results

The preliminary analyses were conducted on 36 completers. These showed large standardized effect sizes on both the EDE-Q subscales (Cohens d ranging from .88-1.65) and on the BED-Q (d = 1.38). The updated effectiveness analyses will be presented at the conference. We expect approximately 70-80 patients to have completed treatment at this time.

Conclusions

Results will be discussed and presented at the conference.

Patient motivations for seeking online therapy for binge eating disorder

Introduction

Binge Eating Disorder (BED) is characterized by repeatedly losing control over eating behavior and consuming large amounts of food within a short period of time. In later years, a growing body of evidence for effectiveness of internet-based Cognitive Behavioral Therapy (iCBT) as treatment for BED has emerged. Regarding the ability to complete a self-help program on the internet, internal self-regulation can be viewed as important.

Objectives

To qualitatively explore patient motivations for seeking therapy for BED according to intrinsic and extrinsic motivation as well as patient reasons for seeking online therapy.

Methods

The research design of this study was qualitatively. The participants were 52 adults suffering from mild to moderate BED. Data consisted of written texts entered by the participants into the online therapy program. The texts addressed the participants’ goals for their treatment course and their motives for seeking online therapy. The texts were analyzed by the means of systematic text condensation.

Results

Pertaining patient motivations for seeking therapy for BED, five main motivations that reached a saturated level in the sample were discovered: wish for control; avoidance of guilt/shame; desire for tools/insights; weight loss; and psychological stress. Participants ranged from one motivational factor to four, no participant had all the motivational factors. Regarding patient reasons for seeking online therapy, the following themes including sub themes were found: online treatment, treatment at home, and flexible treatment.

Conclusions

The results indicate that online therapy for BED may be able to breach some of the barriers there are towards treatment seeking.

Monitowapplication – an investigation of the usability during the first 18 months of commissioning in practice

Introduction

In cognitive behavioral treatment of anxiety disorders, registration of emotions and behavior is an important part of the intervention. Normally, paper and pencil is used but registrations on a mobile application such as MONARCA may be a useful alternative.

Objectives

This study investigates the usability of MONARCA during the first 18 months of commissioning in practice.

Methods

To explore the usability, semi-structured interviews were conducted with seven patients and three therapists, combined with data from a survey questionnaire where 10 patients and 12 therapists rated the usability of the app on the System Usability Scale. Participants were recruited from an outpatient clinic for affective disorders in The Mental Health Services in the Region of Southern Denmark.

Results

Technical performance, time allocation, therapist effort, commitment, enthusiasm, and increased knowledge are imperative factors. Therapists and patients found that the benefits of registering emotions and behaviors on a mobile application were that it was easy for patients to remember to register daily, it was easy to gain an overview over symptom progress, and access to the registrations improved therapist’s ability to prepare sessions.

Conclusions

Overall, the results from the interviews and survey indicated that both patients and therapists found MONARCA useful, but several improvement opportunities regarding application features and use in the treatment course were found.

Disclosure

No significant relationships.

P631Socioeconomic status; how does it influence referral to cardiac rehabilitation after acute myocardial infarction?

Background

The number of patients with low socioeconomic status who are referred to cardiac rehabilitation (CR) has been documented to be relative lower than patients with high SES among all patients hospitalised with acute myocardial infarction (AMI).

Purpose

The aims of this study were to evaluate the referral process to CR and how it is influenced by socioeconomic variables.

Methods

In 2011–2014, 1229 patients were hospitalised with AMI at Department of Cardiology of our University Hospital, Denmark. All were evaluated for participation to CR. Socioeconomic status was measured by personal income, educational level, marital status, and employment and obtained from national registers. Multiple logistic regression assessed socioeconomic determinants in three phases of the referral process to CR: 1. information about CR, 2. wish to participate in CR, and 3. referral to specialiced- or municipality-based CR. All analyses were adjusted for sex, age, and comorbidities.

Results

A total of 1123 (91.4%) patients received information regarding CR. Of these, 854 (69.5%) patients wished to participate in the programme. Income was the most important socioeconomic variable when looking at who were informed about CR (OR 2.17, 95%-CI: 1.0- 4.64) and who wished to participate in CR (OR 1.55, 95%-CI: 1.02–2.35).

Characteristics of study participants Characteristics All participants STEMI NSTEMI UAP n=1229 n=402 n=711 n=116 Male (n, %) 907 (73.8) 322 (80.1) 503 (70.7) 82 (70.7) Age Group (yrs)   <65 591 (48.1) 227 (56.5) 308 (43.3) 56 (48.3)   65–74 371 (30.2) 116 (28.9) 215 (30.2) 40 (34.5)   ≥75 267 (21.7) 59 (14.7) 188 (26.4) 20 (17.2) Baseline Comorbidity   Hypertension 241 (19.6) 62 (15.4) 148 (20.8) 31 (26.7)   Diabetes 14 (1.1) <5 (<1) 8 (1.1) <5 (<1) Charlson Comorbidity Index   Low (0 points) 1088 (88.5) 358 (89.1) 630 (88.6) 100 (86.2)   Moderate/High (>0) 141 (11.5) 44 (10.9) 81 (11.4) 16 (13.8) Civil status (n, %)   Married/Partnership 793 (64.5) 253 (62.9) 449 (63.2) 91 (78.4)   Divorced/Unmarried/Widow 436 (35.5) 149 (37.1) 262 (36.8) 25 (21.6) Occupational status (n, %)   Employed 479 (39.0) 195 (48.5) 240 (33.8) 44 (37.9)   Unemployed/Retired 750 (61.0) 207 (51.5) 471 (66.2) 72 (62.1) Educational status (n, %)   Low 516 (42.0) 144 (35.8) 322 (45.3) 50 (43.1)   Medium 539 (43.9) 201 (50.0) 293 (41.2) 45 (38.8)   High 174 (14.2) 57 (14.2) 96 (13.5) 21 (18.1) Gross income, tertile (n, %)   Low 405 (33.0) 113 (28.1) 251 (35.3) 41 (35.3)   Medium 406 (33.0) 124 (30.8) 247 (34.7) 35 (30.2)   High 418 (34.0) 165 (41.0) 213 (30.0) 40 (34.5) STEMI: ST-elevated myocardial infarction; NSTEMI: non-ST-elevated myocardial infarction; UAP: unstable angina pectoris.

Conclusion

Two out of three patients received referral to CR. However, higher income was proportional with the likelihood of receiving information about CR and willingness to participate in the programme.

Acknowledgement/Funding

the Danish Heart Foundation

Use of antiosteoporotic medication in the Danish ROSE population-based screening study

Use of antiosteoporotic medication in the population-based, risk-stratified osteoporosis strategy evaluation (ROSE) screening study, comparing the use of FRAX followed by DXA with usual care, was examined. Screening increased the overall use of medication. Being recommended treatment by the hospital and higher age increased the likelihood of starting medication, but, nevertheless, a large percentage opted not to start treatment.

INTRODUCTION

The aim of the study was to examine the impact on medication prescription, adherence, and persistence of osteoporotic medicine in the randomized population-based ROSE screening study for osteoporosis.

METHODS

The Danish ROSE study included a population-based random sample of women aged 65-81 years randomized to either a two-step screening program consisting of FRAX followed by DXA for high-risk participants or opportunistic screening for osteoporosis (usual care). This sub-study on the intention-to-treat population examined the impact of the screening program on antiosteoporotic medication redemption rates, adherence, and persistence using Danish registers.

RESULTS

A total of 30,719 of 34,229 women were treatment-naïve. Significantly more participants in the screening group started on antiosteoporotic medication, but no differences in adherence and persistence rates were found. Higher age was associated with a higher likelihood of starting medication. A low Charlson comorbidity score (= 1) was associated with higher treatment initiation but lower adherence and persistence of antiosteoporotic treatment. A total of 31.7% of participants advised to initiate treatment did not follow the advice.

CONCLUSIONS

Screening for osteoporosis using FRAX followed by DXA increased the overall use of antiosteoporotic medication in the screening group without differences in adherence and persistence rates. A large percentage of participants advised to initiate treatment did nevertheless fail to do so.

Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study

There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned.

INTRODUCTION

Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers.

METHODS

The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years.

RESULTS

A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses.

CONCLUSION

The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.

Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study

The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program.

INTRODUCTION

The purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed.

METHODS

Participants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed.

RESULTS

A total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65-80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007).

CONCLUSIONS

Compared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.

Non-participation in systematic screening for osteoporosis-the ROSE trial

Population-based screening for osteoporosis is still controversial and has not been implemented. Non-participation in systematic screening was evaluated in 34,229 women age 65-81 years. Although participation rate was high, non-participation was associated with comorbidity, aging other risk factors for fractures, and markers of low social status, e.g., low income, pension, and living alone. A range of strategies is needed to increase participation, including development of targeted information and further research to better understand the barriers and enablers in screening for osteoporosis.

INTRODUCTION

Participation is crucial to the success of a screening program. The objective of this study was to analyze non-participation in Risk-stratified Osteoporosis Strategy Evaluation, a two-step population-based screening program for osteoporosis.

METHODS

Thirty-four thousand two hundred twenty-nine women aged 65 to 81 years were randomly selected from the background population and randomized to either a screening group (intervention) or a control group. All women received a self-administered questionnaire designed to allow calculation of future risk of fracture based on FRAX. In the intervention group, women with an estimated high risk of future fracture were invited to DXA scanning. Information on individual socioeconomic status and comorbidity was obtained from national registers.

RESULTS

A completed questionnaire was returned by 20,905 (61%) women. Non-completion was associated with older age, living alone, lower education, lower income, and higher comorbidity. In the intervention group, ticking "not interested in DXA" in the questionnaire was associated with older age, living alone, and low self-perceived fracture risk. Women with previous fracture or history of parental hip fracture were more likely to accept screening by DXA. Dropping out when offered DXA, was associated with older age, current smoking, higher alcohol consumption, and physical impairment.

CONCLUSIONS

Barriers to population-based screening for osteoporosis appear to be both psychosocial and physical in nature. Women who decline are older, have lower self-perceived fracture risk, and more often live alone compared to women who accept the program. Dropping out after primary acceptance is associated not only with aging and physical impairment but also with current smoking and alcohol consumption. Measures to increase program participation could include targeted information and reducing physical barriers for attending screening procedures.

Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008

The study investigates an association between phalangeal bone mineral density (BMD) and self-reported passive smoking using data on 15,038 persons (aged 18-95 years), who underwent a BMD scan in the Danish KRAM study. BMD was significantly lower in persons exposed to long-term passive smoking in their home during adulthood.

INTRODUCTION

Smoking is associated with decreased bone mineral density (BMD) and increased risk of osteoporotic fractures. This study aimed to investigate a possible association between BMD at the phalangeal bones and self-reported passive smoking.

METHODS

The study included a cohort of 15,544 men and women aged 18-95 years, who underwent a BMD scan in the Danish KRAM study. BMD scans of the middle phalanges of the second, third and fourth digits of the non-dominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). Also, height, weight and body fat percentage were measured and 96.7% (n = 15,038) of the participants answered a self-reported questionnaire with information on passive smoking, other lifestyle factors, education, etc. The association between passive smoking and BMD was examined using multiple linear regression analysis.

RESULTS

A total of 39.1% (n = 5,829) of the participants had been exposed to passive smoking in adulthood at home. BMD was significantly lower in subjects exposed to passive smoking, 0.343 vs. 0.331 g/cm(2); p < 0.01 (unadjusted) and 0.339 vs. 0.337 g/cm(2); p < 0.05 (adjusted for age, gender, height and weight, and smoking). Multiple linear regression analysis showed that exposure to passive smoking for more than 20 years in adulthood at home was significantly related to BMD when adjusted for potential confounders (men, β = -4.4 × 10(-3); r = -0.05; p < 0.01 and women, β = -2.3 × 10 (-3); r = -0.03; p < 0.05). This relationship was also seen in the group of never smokers (β = -3.3 × 10(-3); r = -0.03; p = 0.01).

CONCLUSION

Our study supports a potential negative effect of long-term passive smoking in adulthood at home on phalangeal BMD.

Salmonella isolated from animals and feedstuffs in Sweden during 1983-1987

This survey describes the frequency of Salmonella in animals and feedstuffs isolated in Sweden 1983-1987. Since 1949 National Veterinary Institute (NVI) has published such reports every fifth year. During the period of this report 760 outbreaks of Salmonella were reported in animals. This includes both domestic and wild animals. The corresponding figure for the previous period was 1266 outbreaks. 56 different serovariants were reported, 17 of these were new to Sweden. In cattle and swine there were a decrease of outbreaks. In poultry 86 outbreaks were reported, compared with 220 outbreaks during the previous five-year period. Swedish feed producing plants are checked both voluntary and compulsory, for the presence of Salmonella in raw materials, scrape and dust samples and compound feed. During 1983-1987 a total of 236 strains at Salmonella were isolated. This is the lowest incidence found during the last 15 years. All consignments of feedstuffs of animal origin intended for import to Sweden has to be examined for the presence of Salmonella. During 1983-1987 8.6% of the consignments were positive for Salmonella and were thus not allowed to be used in Sweden.

Penicillium verrucosum in feed of ochratoxin A positive swine herds

Ochratoxin A contamination of cereal feed grain was monitored during October 1989-September 1990 by analysis of blood samples from slaughter swine in Sweden. The detection of ochratoxin A in swine blood was used as a method to identify swine herds fed ochratoxin A contaminated feed. The contamination level of ochratoxin A in the blood of the positive herds was in the range 2-45 ng/ml with the mean concentration 5.2 ng/ml. Feed samples for mycological analysis were collected from both ochratoxin A positive herds (greater than or equal to ng/ml blood) and ochratoxin A negative herds (less than 2 ng/ml blood). From the ochratoxin A positive herds and the ochratoxin A negative herds 22 and 21 feed samples were collected, respectively. No quantitative differences in mould content, as determined by colony forming units, were observed between the two groups. However, there were differences in the mycoflora. The incidence of storage fungi (Penicillium and Aspergillus spp.) was significantly higher (p less than 0.05) in feed from ochratoxin A positive herds. Particularly, Penicillium verrucosum was found to be significantly more common (p less than 0.001). Altogether 274 isolates were screened for their ability to produce ochratoxin A. Ochratoxin A producers were found only within P. verrucosum; 38% of the 63 isolates produced detectable amounts of ochratoxin A. Ochratoxin A producing isolates of P. verrucosum were found in 60% of the feed samples collected from ochratoxin A positive swine herds and in one sample (5%) of the feed samples collected from the ochratoxin A negative herds.

Salmonella isolated from animals and feedstuffs in Sweden during 1983-1987

This survey describes the frequency of Salmonella in animals and feedstuffs isolated in Sweden 1983-1987. Since 1949 National Veterinary Institute (NVI) has published such reports every fifth year. During the period of this report 760 outbreaks of Salmonella were reported in animals. This includes both domestic and wild animals. The corresponding figure for the previous period was 1266 outbreaks. 56 different serovariants were reported, 17 of these were new to Sweden. In cattle and swine there were a decrease of outbreaks. In poultry 86 outbreaks were reported, compared with 220 outbreaks during the previous five-year period. Swedish feed producing plants are checked both voluntary and compulsory, for the presence of Salmonella in raw materials, scrape and dust samples and compound feed. During 1983-1987 a total of 236 strains at Salmonella were isolated. This is the lowest incidence found during the last 15 years. All consignments of feedstuffs of animal origin intended for import to Sweden has to be examined for the presence of Salmonella. During 1983-1987 8.6% of the consignments were positive for Salmonella and were thus not allowed to be used in Sweden.

Ochratoxin A in swine blood used for evaluation of cereal handling procedures

In a survey during the years 1985, 1986 and 1987 the quality of Swedish feeding grain was followed by the analysis of ochratoxin A in blood collected from swine at slaughter. The swine herds sampled were selected on feed handling procedures used. From information about the feed used, risk parameters for ochratoxin A contamination were identified. The results showed annual variation in the content of ochratoxin A in the grain and that ochratoxin A increased during storage of grain, particularly in the harvest of 1985. Drying of the grain with forced ambient air was found to be inferior to the use of heated forced air. It was also noticed that more than 9% of the grain was contaminated with ochratoxin A regardless of handling. The pronounced difference between the samples studied was seen mainly as a function of geographical origin, with the island of Gotland having a much higher frequency of positive samples than the rest of Sweden. No correlation between ochratoxin A in swine feed and post mortem signs of infectious diseases in the swine herds was found.

Long term studies on bone mineral changes during different lactations in Swedish dairy cattle

Changes in the bone mineral content (BMG) during the first 4 lactations were continuously studied between July 1977 and February 1982 in a total number of 103 dairy cows of different breeds and rearing intensities. The BMG was measured by dichromatic photon absorptiometry in 2 coccygeal vertebrae. Although great individual variations were found, the changes in BMG during the lactation followed a typical pattern with high values during the dry period and low values after calving and during mid-lactation. The influence of body weight on the BMC value is discussed. The changes in BMC were more accentuated during the first lactation, as compared to the subsequent lactations. This could indicate a metabolically more active skeleton in younger cows. In this study no difference in BMC pattern was observed between cows affected or not affected by parturient paresis.

Salmonella isolated from animals and feed stuffs in Sweden during 1978-1982

Regulations concerning the control of Salmonella in animals are more strict in Sweden than in most other countries, though a certain liberalization took place in 1982. The main purpose of these regulations is to prevent transmission of Salmonella infections from animals to man. Veterinarians and laboratories are obliged to report all Salmonella cases to the veterinary authorities. The cases are recorded by the Swedish Board of Agriculture. During the period of this report, 1978-1982, 1266 outbreaks of Salmonella in animals were recorded in Sweden. Isolated strains belonged to 78 different serotypes. The most frequent serotypes were S. typhi-murium (38.5% of the recorded cases) and S. dublin (37%). S. dublin was isolated mainly from cattle, while S. typhi-murium was isolated from a wide range of animal species. Next in frequency are some serotypes isolated mainly from chicken, at rates around 2%: S. livingstone, S. liverpool, and S. agona. Of the 78 isolated serotypes, 25 were never isolated before from animals in Sweden. There were 687 outbreaks of Salmonella recorded in cattle. Predominant serotypes are S. dublin (67% of the outbreaks in cattle) and S. typhi-murium (28%). The outbreaks of S. dublin, like earlier in the sixties and seventies, occurred mainly in south-eastern Sweden. The recorded occurrence of Salmonella in swine continued to decrease. During this period only 37 outbreaks were diagnosed. Of these more than half were caused by S. typhi-murium. S. choleraesuis was isolated from 6 cases only.(ABSTRACT TRUNCATED AT 250 WORDS)

Ochratoxin A in blood of slaughter pigs

The global ochratoxin A contamination of Swedish feed cereals was studied by analysis of pig blood samples from 122 different herds. The samples were collected at seven Swedish slaughterhouses. The ochratoxin A analysis showed 21% of the samples to contain greater than or equal to 2 ng ochratoxin A per ml. Samples from Visby showed a significantly higher frequency of contamination compared with the rest of the country.

The effect of feeding diets containing avoparcin and monensin on the occurrence of Salmonella in caecum and liver in experimentally infected chickens

In two experiments (Experiments A and B) chickens experimentally infected with S. infantis at 7 days of age and fed diets containing both avoparcin (10 ppm) and monensin (90 ppm) showed a higher frequency of Salmonella-positive livers and higher caecal counts of Salmonella 1 and 2 weeks after challenge than similarly infected chickens fed only avoparcin (10 ppm). The results may indicate a synergistic action between the two drugs on the ability of chickens to withstand Salmonella infections.

The influence of age, breed, rearing intensity and exercise on the incidence of spavin in Swedish dairy cattle. A clinical and morphological investigation

The hocks of tied cows of a Swedish dairy herd of different breeds were radiographed. Osteoarthrosis of the arthrodial joints (spavin) was found in 37 % of the animals. Changes were seen before the cows were 2 years old, and they increased in severity with increasing age. Macroscopic and histologic examination revealed that there was osteoarthrosis also in many radiologically normal hocks. The study shows that the frequency of spavin in tied dairy cows is higher than clinical signs indicate. Apparently only cows with fusion of the arthrodial joints show the stiff hind leg movements considered typical of spavin. Differences in the incidence of spavin were found between the different breeds. Cows of the Swedish Friesian breed had the lowest (20%) and cows of the Jersey breed had the highest (50%) incidence of spavin. However, as regards the Jersey breed this was due to the high incidence (71%) found in cows raised on a high intensity feeding during the young stock period. Among the SJB cows raised on a normal intensity feeding the incidence of spavin was 25 %. Such a relationship between high young stock feeding intensity and the incidence of spavin was not seen within the other breeds. The cows in another herd with loose housing had a lower frequency of spavin than the tied cows. Offspring of animals with spavin had a higher incidence of spavin than the offspring of animals without spavin.