Bladder distension : aspects of a healthcare-related injury

Lower urinary tract symptoms (LUTS) are common health problems. For the individual, LUTS is troublesome and can greatly affect the health-related quality-of- life (HRQOL). One cause of LUTS is urinary retention (inability to void in the presence of a full bladder); a well-known complication following hospital care. If the bladder volume exceeds 500 ml there is a risk of overdistension of the muscle fibres in the bladder wall; bladder distension. This can result in motility problems with post-void residual volumes, urinary tract infections and an inability to void. If the bladder becomes stretched too far, or for a long period, the bladder may be permanently damaged and lose its ability to contract sufficiently for the rest of the person’s life. Bladder damage due to overdistension can be classified as a patient injury; harm caused to a patient as a result of their healthcare, and which could have been avoided. The overall aim of this thesis was to improve patient-safety by providing research evidence for bladder monitoring procedures and increase knowledge and awareness of bladder distension as a healthcare-related injury. Study I was a prospective observational study of peri-operative bladder volumes among orthopaedic or general surgical patients. Bladder volumes were measured on three occasions; after emptying the bladder before being transported to the operating theatre, and then both immediately before and after surgery. Thirty-three of the included 147 patients (22%) developed bladder distension (>500 ml), eight preoperatively and 25 postoperatively. Orthopaedic patients were more likely to develop both preoperative and postoperative bladder distension than surgical patients and had significantly higher post-void residual volumes Age, gender and time of anaesthesia could not predict bladder distension. Study II was a randomised controlled trial testing whether a protocol with frequent pre-operative ultrasound monitoring of bladder volumes starting in the ER could reduce the risk of postoperative bladder distension among acute orthopaedic patients. The result showed that patients in the control group (no preoperative scanning) were more prone to postoperative bladder distension than patients in the intervention group (OR=1.81, 95% confidence interval 1,02-3,23, p=0.042). This association remained after adjusting for confounding factors; neither gender, age nor volume of perioperative fluid affected the outcome. Studies III and IV focused on the impact of bladder distension from the patient’s perspective. Study III was a prospective, longitudinal follow-up survey exploring lower urinary tract symptoms and health-related quality of life up to three months after acute orthopaedic surgery. Patients who have had postoperative bladder distension reported more LUTS and lower HRQOL than patients without bladder distension. Study IV used a qualitative design with narrative interviews of 20 patients who had reported a healthcare-related injury to the Swedish Patient Insurance LÖF, and who had had their injury classified as avoidable bladder damage due to over-distension. The result showed that micturition problems after bladder distension affected the everyday life through several practical and social constraints. Suffering from pain and infections, impaired sex life and strong concerns for the future were other findings. Lack of knowledge, insufficient routines, mistrust and poor communication between the staff and the patient were contributing factors leading to the injury. Conclusions: Bladder distension is a common healthcare-related injury that can cause suffering and practical, emotional and psychosocial problems with a great impact on the life of the person affected, and anxiety for the future. Frequent bladder monitoring starting in the ER can reduce postoperative bladder distension among acute orthopaedic patients. Safe and effective prevention of bladder distension is based on early recognition

Evaluation of Strategies to Reduce Equine Strongyle Infective Larvae on Pasture and Study of Larval Migration and Overwintering in a Nordic Climate

Simple Summary All grazing horses are exposed to parasites that when ingested have the potential to cause disease. Drugs designed to kill parasites in horses have been used extensively since the 1960s, but this intensive use has led to the development of drug resistance, emphasising the need for more sustainable methods to lessen parasite burdens. The efficacy and suitability of pasture-management methods aiming to reduce the level of parasitic larvae in the herbage are, however, dependent on the prevailing weather conditions. The aim of the present study was therefore to generate data on the effect of regular faecal removal and harrowing of the pasture on reducing the number of parasites in herbage in a Nordic climate. Furthermore, the ability of parasite larvae to migrate from faeces to the herbage and to survive the winter season in Sweden's cold temperate climate was investigated. Twice-weekly faecal removal significantly reduced the number of larvae on the pasture, whereas harrowing on a single occasion in the summer under dry weather conditions did not. Parasite larvae migrated as far as 150 cm from faecal pats and were able to survive one winter season, with two years of rest from grazing horses required to achieve parasite-free pasture. Horses, as grazing animals, are inadvertently exposed to intestinal parasites that, if not controlled, may cause disease. However, the indiscriminate use of anthelmintic drugs has led to drug resistance, highlighting the need for pasture-management practices to reduce the level of parasitic exposure and lessen reliance on drugs. The efficacy of such methods depends both on the epidemiology of the parasites and the prevailing weather conditions. The aim of the study was to investigate the effect of faecal removal and harrowing on reducing the number of parasite larvae in herbage. Moreover, the migratory and survival ability of strongyle larvae in a Nordic climate was studied. Faeces from horses naturally infected with strongyle nematodes were used to contaminate pastures and grass samples were collected to harvest larvae. Twice-weekly faecal removal significantly reduced larval yields, whereas harrowing on a single occasion under dry weather conditions in the summer did not. Strongyle larvae were able to migrate 150 cm from the faecal pats, but most larvae were found within 50 cm. Both Cyathostominae and S. vulgaris survived the winter months with larvae harvested up to 17-18 months after faecal placement. Resting of pastures for one year greatly reduced the parasite level, but two years of rest were required for parasite-free pasture

Parasite Occurrence and Parasite Management in Swedish Horses Presenting with Gastrointestinal Disease - A Case-Control Study

Simple Summary: Abdominal pain, colic, is a common clinical sign in horses, sometimes reflecting life-threatening disease. One cause of colic is parasitic infection of the gut. Various drugs, anthelmintics, can be used to reduce or eliminate such parasites. However, frequent use has led to problems of drug resistance, whereby many countries now allow anthelmintics to be used on a prescription-only basis. In Sweden, this has led to a concern that parasitic-related colic in horses is increasing. This study aimed to investigate whether horses with colic differed in parasitological status compared to horses without colic. A secondary aim was to collect information regarding current parasite control measures used by horse owners. Exposure to S. vulgaris, a parasite with the potential to cause life-threatening disease, appeared high as determined by the presence of antibodies in the blood. Horses with inflammation in the abdominal cavity had higher antibody levels than other causes of colic. Despite new legislation, 29% of owners did not use fecal analyses for parasites and the use of extended methods to diagnose specific parasites was low. Also, owners rarely used alternative methods to reduce the pasture parasite burden. The study suggests a need for education in the use of both fecal analyses and pasture management.Abstract All grazing horses are exposed to intestinal parasites, which have the potential to cause gastrointestinal disease. In Sweden, there is a concern about an increase in parasite-related equine gastrointestinal disease, in particular Strongylus vulgaris, since the implementation of prescription-only anthelmintics approximately 10 years ago. In a prospective case-control study, parasitological status, using fecal analyses for strongyle egg counts, the presence of Anoplocephala perfoliata eggs and S. vulgaris Polymerase chain reaction (PCR) as well as serology for S. vulgaris, were compared between horses presenting with or without gastrointestinal disease at a University hospital during a one-year period. Information regarding anthelmintic routines and pasture management was gathered with an owner-filled questionnaire. Although the prevalence of S. vulgaris PCR was 5.5%, 62% of horses were positive in the enzyme-linked immunosorbent assay (ELISA) test and horses with peritonitis showed higher antibody levels for S. vulgaris, as compared to other diagnoses or controls. Overall, 36% of the horse owners used only fecal egg counts (FEC), 32% used FEC combined with specific diagnostics for S. vulgaris or A. perfoliata, and 29% dewormed routinely without prior parasite diagnostics. Effective management methods to reduce the parasitic burden on pastures were rare and considering exposure to S. vulgaris appears high; the study indicates a need for education in specific fecal diagnostics and pasture management

Demonstration of reduced efficacy against cyathostomins without change in species composition after pyrantel embonate treatment in Swedish equine establishments

Consisting of approximately 50 different species, the cyathostomin parasites are ubiquitous in grazing horses. Coinfection with several species is common, and large burdens can cause the fatal disease of larval cyathostominosis. Due to intense anthelmintic drug use, cyathostomin resistance has developed to all available anthelmintic drug groups. Resistance to the anthelmintic drug pyrantel (PYR) has been documented in over 90% of studies published over the past two decades. In Sweden, a study performed in the early 2000s only confirmed resistance in 4.5% of farms. Further, prescription-only administration of equine anthelmintic drugs was enforced in Sweden in 2007. However, it is unknown if this conservative drug use has maintained PYR efficacy in cyathostomins. The aim of the present study was to investigate the effect of PYR on cyathostomin infection in Sweden using fecal egg count reduction tests (FECRTs). Further, the effect of PYR treatment on cyathostomin species composition was studied using metabarcoding. Sixteen farms with at least six horses excreting a minimum of 100 eggs per gram feces were included. Using the current World Association for the Advancement of Veterinary Parasitology (WAAVP) guidelines, PYR resistance was demonstrated in nine of farms, with seven farms showing full susceptibility. Farms with low biosecurity measures had significantly lower efficacy of PYR treatment. The most common cyathostomin species were Cylicocyclus nassatus, Cyathostomum catinatum, Cylicostephanus longibursatus, Cys. calicatus, Cys. goldi, Cys. minutus, Coronocyclus coronatus and Cya. pateratum, accounting for 97% of all sequence reads prior to treatment. Of these, Cyc. nassatus and Cya. catinatum had the highest occurrence, accounting for 68% of all sequence reads prior to PYR treatment. Treatment did not significantly affect the species composition. The results highlight the importance of drug efficacy testing when using PYR to treat cyathostomin infection, even when selective anthelmintic treatment and thus low treatment intensity, is used on the farm

Retained efficacy of ivermectin against cyathostomins in Swedish horse establishments practicing selective anthelmintic treatment

Cyathostominae are ubiquitous to grazing horses and regarded the most prevalent internal parasite in the horse. Unfortunately, decades of indiscriminate use of anthelmintic drugs have resulted in the development of resistance in cyathostomins to all currently available drug groups, the most recent being a documented lack of efficacy to the macrocyclic lactones (ML). In vivo determination of anthelmintic resistance in horses most often utilises the faecal egg count reduction test (FECRT). Further, a shortened egg reappearance period (ERP) can indicate a change in response to the applied treatment and suggest an upcoming reduction of efficacy. Although both true resistance as demonstrated by the FECRT and shorter ERPs after ML treatment have now been shown in cyathostomins worldwide, the efficacy of ML as regards to cyathostomins in Sweden is currently unknown. The aim of the present study was therefore to determine FECRTs and ERPs after ivermectin (IVM) treatment in Swedish horses. Sixteen equestrian establishments with a minimum of six horses excreting at least 150 eggs per gram faeces (EPG) at screening were selected. For each establishment, FECRTs and ERPs were determined by collecting faecal samples prior to and 14 days after IVM treatment (200 mu g/kg), and thereafter at weekly intervals for a total of eight weeks. All participants responded to a questionnaire detailing pasture management methods and anthelmintic routines.Questionnaire results showed that the majority of establishments (69%) only treated horses with anthelmintic drugs if indicated by faecal diagnostics and all of the establishments had a mean FECRT exceeding 99.0% and ERPs ranging from six to over eight weeks. The ERP was shown to increase with age as young individuals were shown to excrete cyathostomin eggs earlier after treatment compared with older horses (R = 0.21, p = 0.015). Riding schools, stud farms and those declaring not to use separate summer and winter paddocks had significantly shorter ERPs (p <0.01).In conclusion, retained ERPs and no confirmed resistance to IVM were found in Swedish equine establishments practising selective anthelmintic treatment, and supports the use of selective deworming regimens as a means of reducing the risk of anthelmintic resistance development

Effects of supervision on tax compliance:Evidence from a field experiment in Austria

We conduct a field experiment on tax compliance, focusing on newly founded firms. As a novelty the effect of tax authorities’ supervision on timely tax payments is examined. Interestingly, results show no positive overall effect of close supervision on tax compliance

Clinical features and treatment response to differentiate idiopathic peritonitis from non-strangulating intestinal infarction of the pelvic flexure associated with Strongylus vulgaris infection in the horse

Background Peritonitis in horses secondary to non-strangulating infarction (NSII) has a guarded prognosis, even after intestinal resection. In contrast, horses with idiopathic peritonitis respond well to medical treatment. Affected horses in both cases often show signs of both colic and systemic inflammation, but early diagnosis is crucial for optimal treatment and an accurate prognosis. One cause of NSII is thrombus formation secondary to Strongylus vulgaris larval migration. There has been a documented increase in S. vulgaris prevalence in Sweden since the implementation of selective anthelmintic treatment in 2007, which subsequently could result in a rise in NSII cases. In a retrospective clinical study, medical records from cases diagnosed with NSII of the pelvic flexure or idiopathic peritonitis from three equine referral hospitals in Sweden during 2017-2020 were reviewed. Information including demographic data, relevant medical history, and clinical- and laboratory parameters were obtained from patient records. To facilitate the differentiation between cases of idiopathic peritonitis and cases with confirmed NSII of the pelvic flexure, the aim of the study was to compare clinical and laboratory parameters, clinical progression and initial response to antimicrobial treatment. A secondary aim was to compare survival-rates. Results Horses with NSII (n = 20) were significantly more likely to present during the winter months with a poorer response to medical treatment within 48 h. Cases of idiopathic peritonitis (n = 107) had a 100% survival rate with medical treatment, although one case required surgical correction of a colon displacement. In comparison, all confirmed NSII cases were non-responsive to antimicrobial treatment, with a survival rate to discharge of 50% after colon resection. Specific rectal findings and peripheral blood neutropenia were strongly associated with NSII. Conclusions In Sweden, idiopathic peritonitis cases still predominate over S. vulgaris associated NSII cases and have an excellent survival rate with antimicrobial treatment. However, horses presenting with septic peritonitis during the winter months with a palpable rectal mass and displaying fever and colic signs beyond 48 h of medical treatment are likely to suffer from NSII of the pelvic flexure and should be considered for abdominal surgery

Vildsvin i de Nordiska länderna : en rapport på uppdrag av Nordiska Ministerrådet

Vildsvinet (Sus scrofa) förekommer i stora delar av Europa, södra Asien och norra Afrika. Arten har introducerats till Nordamerika, Sydamerika, Nya Zeeland och Australien. I Europa har vildsvinet ökat kraftigt både till antal och utbredning under de senaste trettio åren och i Norden förekommer vildsvin i Finland, Sverige, Norge och Danmark. Vildsvin är i ett historiskt perspektiv en naturlig del av den Nordiska faunan, med undantag för Island. Arten utrotades dock under olika perioder (1000-talet i Norge, 1700-talet i Sverige, 1800-talet i Danmark) och har sannolikt inte funnits naturligt i Finland under de senaste 8 000 åren. Under de senaste decennierna har dock vildsvinet återkommit till Sverige genom rymningar från hägn och via naturlig spridning från grannländer till Finland, Danmark och Norge. Artens naturliga förmåga att snabbt föröka sig har medfört en stor population i Sverige, med påföljande och ökade skador framför allt inom jordbruket. Även vildsvinsolyckor i trafiken har ökat kraftigt i takt med den ökande vildsvinsstammen. Den ökande populationen innebär också att risken för spridning av sjukdomar ökar, framför allt är oron inom svinproduktionsnäringen påtaglig. Det allvarligaste hotet anses vara Afrikansk svinpest (ASF) som sprids bland vildsvin i stora delar av forna Östeuropa och länder som gränsar till väst. Under våren 2021 fick Sveriges lantbruksuniversitet (SLU) i uppdrag av Nordiska Ministerrådet att sammanfatta kunskapsläge, förvaltningsmål och policys kring vildsvinssituationen i de Nordiska länderna med särskilt fokus på nuläge och framtiden. Förekomst och övergripande nationella mål för vildsvinspopulationerna I Sverige är den övergripande och nationella målsättningen för vildsvinspopulationen att nå ”en hållbar, kontrollerad och frisk population av vildsvin, anpassad till regionala och lokala förutsättningar”. I Finland är målsättningen att minska stammen till 500–600 djur. I Norge definieras vildsvinet som en främmande art och det övergripande förvaltningsmålet är ”minsta möjliga antal vildsvin på minsta möjliga område”. I Danmark finns ett tydligt mål att vildsvin inte ska tillåtas återetablera sig. I Sverige har vildsvinspopulationen ökat kraftigt sedan 80-talet och uppskattningsvis finns idag minst 300 000 vildsvin i landet. Utbredningen sträcker från söder upp till ungefär i höjd med Gävleborgs och Dalarnas län. I Finland har en population etablerats genom att vildsvin vandrat in från sydöst. Förra året uppskattades den finska populationen omfatta omkring 3 500 djur. Populationen är tätast i sydöstra Finland men vildsvin förekommer ända upp till Norra Österbotten. I Norge dokumenterades föryngring av frilevande vildsvin för första gången 2005. Därefter har en population på 400–1 200 djur etablerats i ett område längs gränsen mot Sverige, från Halden i söder till Kongsvinger i norr. Genom vildsvinets kraftiga expansion i Europa, inklusive Tyskland, har vildsvin också vandrat in i Danmark söderifrån och år 2018 fanns en stam på 100–150 djur i landet. Därefter har Danmark i stort sett eliminerat alla frilevande vildsvin samt uppfört ett stängsel längs hela den tyska landsgränsen och på så sätt minskat risken för spridning av ASF från Tyskland. Skador på gröda, mark och i trafiken Vid större tätheter kan vildsvin orsaka stora skador inom jordbruket. Omfattningen av skadorna påverkas av flera faktorer, men antalet vildsvin är den främsta parametern varför vi ser betydligt färre skador i Finland och Norge än i Sverige. När vildsvinen söker efter föda i form av maskar, insekter och växtdelar skadas jordbruksgrödor genom att de trampar ned, bökar och betar. Skador orsakade av vildsvin innefattar även maskinskador då vildsvinen bökat upp jord och sten. I Sverige, år 2015, beräknades kostnaderna för vildsvinens skador inom jordbruket till mer än en miljard SEK per år. Även anläggningar som golfbanor och trädgårdar kan skadas av bökande vildsvin. Ökande vildsvinstammar innebär också fler trafikolyckor med vildsvin inblandade. Under perioden 2003–2016 beräknas den totala kostnaden för vildsvinsrelaterade trafikolyckor i Sverige ha ökat med 536%, från 1,9 miljoner till 12,3 miljoner EUR. Sjukdomsspridning ASF är en anmälningspliktig virussjukdom som kan drabba vildsvin och tamsvin. Sjukdomen smittar inte människa men klassas som en epizooti eftersom den kan orsaka stora ekonomiska förluster för grisnäringen. Vaccin är under utveckling men botemedel saknas och sedan 2014 förekommer sjukdomen i flera länder inom EU med etablering i vildsvinsstammar i Tyskland, Polen, Slovakien, Ungern och de baltiska länderna, dock inte i Norden. ASF finns även i Ryssland (sedan 2009), Ukraina och Serbien. Smitta sprids genom kontakt mellan djur och via indirekt överföring av virus. Viruset kan dessutom överleva flera år i kylt, fryst, rökt eller saltat kött, varför även charkprodukter från drabbade länder utgör ett hot. Även import av foder kan utgöra en risk för spridning. Andra förvaltningsrelevanta sjukdomar som förekommer bland vildsvin inkluderar bland annat trikiner och salmonella. Ekosystemtjänster Olika intressegrupper, och individer inom intressegrupper, värderar ofta samma ekosystemtjänst olika beroende på kontext och grad av påverkan eller otjänst. Vildsvinets påverkan på sin omgivning genom bök, födointag och tramp är i fel kontext en uppenbar otjänst medan bök i till exempel en granmonokultur, i lagom dos, kan utgöra en viktig tjänst för att öka den biologiska mångfalden. Övriga mer uppenbara tjänster som arten anses bidra med i olika utsträckning är fröspridning, spillning, asätande, biologisk kontroll av skadeinsekter, produktion av viltkött och rekreation med mer. Åtgärder och policys i de Nordiska länderna Den viktigaste åtgärden för att minska vildsvinens negativa effekter i de nordiska länderna är ökat jakttryck. Samverkan mellan markägare, jägare och andra förvaltande aktörer framhålls ofta som en springande punkt för att nå förvaltningsmålen, både lokalt och nationellt. Gemensamt för län derna är exempelvis lättnader i jaktbestämmelserna samt information/utbildning för att öka jakten. I Sverige pågår ett omfattande arbete för att förenkla och öka avsättningen av vildsvinskött till marknaden och på så sätt motivera till ökad jakt. I Finland och Norge kan jägare erhålla ersättning för skjutna djur genom att sända in prov för smitto- och hälsoövervakning. Danmark har sedan 2018 intensifierat ansträngningarna för att utrota vildsvinet genom att bygga ett vildsvinsstängsel längs hela den dansk-tyska gränsen och genom intensiv jakt vid bevakade utfodringsplatser. Åtgärder för att förhindra ASF är aktuella i alla nordiska länder, och tycks vara särskilt centrala i Danmark och Finland, som gränsar direkt till länder med ASF. Danmarks huvudsakliga åtgärd för att hindra smittspridning via vildsvin är att förhindra dem från att etablera sig i landet. I Finland har tillsynen intensifierats genom provtagning, regler, rekommendationer, och gränskontroller, men också genom regler för import av foder och köttprodukter. Informationsinsatser om ASF och dess smittvägar har gjorts i alla länder. Information har exempelvis riktats till jägare, lantbrukare, allmänhet och turister. I Norge och Finland finns krav på att observationer av sjuka eller självdöda vildsvin ska rapporteras till veterinär eller myndighet. I samtliga nordiska länder med vildsvin finns övervakningsprogram där djuren analyseras med avseende på ASF och andra sjukdomar. Sammanfattande överväganden med särskilt fokus på behov av samverkan i Norden Ett Nordiskt samverkansråd liknande samverkan kring förvaltningen av de stora rovdjuren i Sverige, Norge och Finland skulle sannolikt koordinera och effektivisera vildsvinsförvaltningen, särskilt i gränsbygder. Ett sådant samverkansråd kan driva frågor och initiera diskussioner kring: • gemensamma lagar, regler och riktlinjer med avseende på jakt, sjukdomsövervakning (provtagning), export/import och regler kring försäljning av vildsvinskött och förädlade charkuterier. • ett ökat forsknings-, övervaknings och kunskapsutbyte mellan länderna gällande populationsövervakning, inventering av jord/skogsbruksskador, skadebekämpning, jakt och smittskyddsåtgärder. Förvaltnings- och övervakningsinriktad forskning bedrivs i olika omfattning i såväl Sverige, Norge och Finland. • samordnad information kring vilka förvaltningsåtgärder som empiriskt varit framgångsrika och vilka regler/riktlinjer/rekommendationer som gäller i de olika nordiska länderna. Det är i nuläget svårt att få en aktuell överblick över olika myndigheters senaste beslut, när de börjar gälla, huruvida det är rekommendationer eller krav och så vidare