Gender policy and gender equality in a public health perspective : Investigating morbidity and mortality in Sweden and 22 OECD countries

The aim of this thesis is to investigate gender policy and gender equality as determinants of health. Data at individual, municipal and country level were employed, and the settings were Sweden and 22 OECD countries. The studies span the time period 1973-2008. In Study I, gender equality at municipal level (N=289) was measured using indicators of political participation, division of labour in the private and public spheres, and the distribution of economic resources. The outcomes were life expectancy and number of days of compensation for sickness absence and disability. The data were cross-sectional (2000-2004) and linear regression was used. Gender equality was correlated with lower life expectancy and higher levels of sickness and disability for both men and women. In Study II, a cohort of parents (N of approx. 75,000) were followed from 1980 to 1999. The aim was to assess possible interaction between gender equality at couple (between partners) and local level. For this purpose, a combinatorial index was constructed. The outcome was number of days compensated from sickness insurance during 1986-1999, with a cut-off point at the 85 % percentile. Logistic regression was used. Among fathers, those who were traditionally unequal with their partner and lived in an equal municipality had higher levels of sick-leave. Mothers who earned less and/or had a lower occupational position than their partner had lower levels of sick-leave, especially when they lived in a traditional municipality. Study III aimed to classify 22 OECD countries into homogenous clusters, using hierarchical cluster analysis for 1979, 1989, 1999 and 2004. Included were indicators of taxes, parental leave, pensions, social insurances and social services in kind to reflect Sainsbury’s three gender policy regimes. The empirical classification did not completely correspond to Sainsbury’s theoretical typology. Rather than an emerging separate gender roles regime, there was a compensatory breadwinner cluster, distinguished by compensatory measures in the pension system directed at carers and extended childcare leave following maternity leave. A male breadwinner cluster was found, with the core feature of having a tax system that supports single (as opposed to dual) earner families. From 1989 there was an earner-carer cluster, characterised by generous parental leave, high social services expenditure, and universal basic pensions. In Study IV, the cluster solution for 2004 and specific policy indicators for 1973-2008 were used as predictors, and the outcomes were mortality from external causes and circulatory disease. For this repeated measures model, hierarchical linear regression was used. Both the earner-carer cluster and specific policies, i.e. generous parental leave, high social services expenditure and universal basic pensions, were associated with a smaller gender gap in external cause mortality, primarily due to increased female mortality. For circulatory disease mortality, both the earner-carer and the compensatory breadwinner cluster experienced a larger decrease in male mortality over time. In conclusion, the relationship between gender equality and health differed according to the unit of analysis and the outcome studied, and also varied between men and women. Based on these results, hypotheses for future studies are formulated

Biosecurity level and health management practices in 60 Swedish farrow-to-finish herds

Background: Biosecurity measures are important tools to maintain animal health in pig herds. Within the MINAPIG project, whose overall aim is to evaluate strategies to raise pigs with less antimicrobial use, biosecurity was evaluated in medium to large farrow-to-finish pig herds in Sweden. In 60 farrow-to-finish herds with more than 100 sows, the biosecurity level was evaluated using a previously developed protocol (BioCheck). In a detailed questionnaire, internal and external biosecurity was scored in six subcategories each. An overall score for biosecurity was also provided. Information regarding production parameters as well as gender and educational level of personnel working with the pigs was also collected. Descriptive statistics were used to examine the recorded data.Results: The median scores for external and internal biosecurity were 68 and 59, respectively, where 0 indicates total absence of biosecurity and 100 means maximal possible biosecurity. The subcategories for external and internal biosecurity that had the highest scores were "Purchase of animals" (external) and "Nursery unit"/"Fattening unit" (internal), while "Feed, water and equipment supplies" (external) and "Measures between compartments and equipment"/"Cleaning and disinfection" (internal) received the lowest scores. A female caretaker in the farrowing unit, a farmer with fewer years of experience and more educated personnel were positively associated with higher scores for some of the external and internal subcategories. In herds with < 190 sows, fattening pigs were mixed between batches significantly more often than in larger herds.Conclusions: The herds in this study had a high level of external biosecurity, as well as good internal biosecurity. Strong biosecurity related to the purchase of animals, protocols for visitors, the use of all-in, all-out systems, and sanitary period between batches. Still, there is room for improvement in preventing both the introduction of disease to herds (external) and the spread of infections within herds (internal). Systems for animal transport can be improved and with respect to internal biosecurity, there is especially room for improvement regarding hygiene measures in and between compartments, as well as the staff's working procedures between different groups of pigs

Wild rodents as carriers of potential pathogens to pigs, chickens and humans

The aim of this thesis was to investigate the specific risks that rodents constitute for proliferation of pathogens and transmission of those to farm animals, and indirectly to humans. Rodents were captured in pig and chicken flocks, in wastewater treatment plants and other urban environments. The enteric pig pathogens Brachyspira hyodysenteriae and B. pilosicoli and the chicken pathogen B. intermedia were detected. Fingerprinting by Random Amplified Polymorphic DNA and Pulsed Field Gel Electrophoresis indicated cross-species transmission of B. pilosicoli, B. intermedia, B. innocens, and B. murdochii between rodents and farm animals. A phylogeny of murine brachyspiras was established. Three new genetic rodent variants of Brachyspira spp. were discovered, for which the provisional names ‘B. rattus’, ‘B. muridarum’ and ‘B. muris’ were suggested. Lawsonia intracellularis and encephalomyocarditis virus (EMCV) were detected in rodents trapped on pig farms. The clinical significance of leptospirosis in Sweden is reportedly minor. However, the detection of pathogenic leptospiras in mice, rats and a water vole indicated that rodents constitute a potential hazard to pigs and humans. Campylobacteriosis, salmonellosis and yersiniosis are the most frequently reported zoonosis in Europe. Rodents in the study carried C. jejuni, C. coli and C. upsaliensis. Identical isolates of the human pathogen Yersinia enterocolitica bioserotype 4/O:3 were isolated both from rodents and pigs on the same farm, indicating cross-species transmission. Salmonella enterica could not be detected by the applied real-time PCR, indicating a low sensitivity of this test. No zoonotic variants of Giardia spp. or Cryptosporidium spp. were detected. All samples were tested negative for Trichinella spp. indicating that trichinellosis is not a widespread infection in wild rodents in Sweden. No rodents were seropositive to Toxoplasma gondii. In conclusion, the results show that rodents could be a risk for the transmission of the pig pathogens Lawsonia intracellularis, Brachyspira hyodysenteriae, B. pilosicoli, pathogenic Leptospira spp. and EMCV, and zoonotic Campylobacter species and Yersinia enterocolitica 4/O:3 in Sweden

Assigning defined daily doses animal: a European multi-country experience for antimicrobial products authorized for usage in pigs

Objectives To establish a consensus defined daily dose animal (DDDA) for each active substance (AS) and administration route for porcine veterinary antimicrobial products authorized in four European countries, thus allowing cross-country quantification and comparison of antimicrobial usage data. Methods All veterinary antimicrobial products authorized for porcine use in Belgium, France, Germany and Sweden were listed for each administration route. First, separate DDDAs for each product were defined based on the recommended dosing for the main indication. Second, a consensus DDDA was established by taking the mean of the DDDAs for each product within a certain category of AS plus administration route. Results One-hundred-and-fifty-nine, 240, 281 and 50 antimicrobial products were licensed in Belgium, France, Germany and Sweden, respectively, in February 2013. Large variations were observed for dosage and treatment duration recommendations between products and between countries for the same ASs. Only 6.8% of feed/water and 29.4% of parenteral AS groups had the same recommended dosage in the four countries. Conclusions This study presents a consensus DDDA list for use in the quantification and comparison of antimicrobial consumption. Four major recommendations have been formulated: (i) urgent need for harmonization of authorization and recommended summary of product characteristics (SPC) dosages; (ii) expand the developed preliminary DDDA list to include all authorized veterinary medicinal products in all EU member states and for all (food-producing) animal species; (iii) improved accessibility of country-specific SPC data would be preferable; and (iv) statement of the ‘long-acting' duration of a product in the SP

Experimental inoculation of Treponema pedis T A4 failed to induce ear necrosis in pigs

Ear necrosis is a syndrome affecting pigs shortly after weaning and is regarded as an animal welfare issue. The etiology is unknown but Treponema spp., predominantly Treponema pedis, are commonly detected in the lesions. Oral treponemes have been suggested as source of infection, transferred by biting and licking behavior. In this study, five pigs were intradermally inoculated with Treponema pedis strain T A4 with the aim of investigating if this strain would induce ear lesions. Three pigs served as controls. The inoculation was repeated after 29 days, and the study continued for 56 days. Serum samples were collected throughout the study and analyzed by ELISA for IgG antibodies towards T. pedis T A4 lysate. Skin biopsies were taken from the inoculation area at the end of the study. Gingival samples were collected and cultivated for treponemes, for comparison to the inoculation strain and to follow colonisation. The challenged pigs did not develop any clinical signs of infection and no spirochetes were detected in sections from skin biopsies. The number of Treponema-positive gingival samples increased during the study. In the challenge group, IgG towards the bacterial lysate peaked 7 days after each inoculation and decreased rapidly hereafter. In the control group a weak IgG response was observed after the second inoculation, possibly caused by the oral treponemes

Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973–2008

BACKGROUND: Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours. METHODS: 22 OECD countries were followed 1973–2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units. RESULTS: Both the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality. CONCLUSION: Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach – cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made

Potential alternatives to antimicrobials in pig production based on perceived effectiveness, feasibility and return on investment

Based on a questionnaire returned by 111 pig health experts from six European countries a list of potential alternatives to antimicrobials was ranked. These althernatives provide input for further studies to find strategies to reduce the widely discussed use of antimicrobials and the potential risk from antimicrobial resistance