Enabling Passive Immunization as an Alternative to Antibiotics for Controlling Enteric Infections in Production Animals

Enteric infections cause major problems in most intensive animal production sectors, including poultry, pigs and cattle, leading to disease, reduced production and compromised welfare. In addition some of these infections are zoonotic, and they are to a large extent responsible for the continued massive use of antibiotics in food animals. Thus there is a pressing need for economically feasible, efficient, non-antibiotics based means for controlling the problem. Passive immunization has been known for decades as an efficient way of endowing humans or animals with short-term (weeks) immunity. To control enteric infections by passive immunization a bolus of immunoglobulin may simply be administered orally. For this to work, large amounts of active immunoglobulins are needed. To be a real alternative to antibiotics the price of the immunoglobulin product needs to be low. We combined an efficient and mild high-capacity method for extracting immunoglobulins directly from raw materials like milk, whey and blood plasma with a novel method for stabilizing activity. In a first experiment a total of 15 kg unstabilized bovine immunoglobulin was purified from whey (35.000 liters) and administered to colostrum-deprived calves (225-300 g pr calf during the first 24 hours after birth). No difference in resulting immunoglobulin serum concentration, weight gain or disease frequency were seen in this group of calves compared to a control group given full access to high-quality colostrum. The effect of orally administered bovine immunoglobulin is currently being tested in a calf herd with persistent diarrhea problems. Furthermore, it was shown in a Campylobacter challenge model in chickens that caecal and faecal counts of Campylobacter were between 0.5 and 1.0 logs lower in birds when given 200 mg avian immunoglobulins orally together with the challenge (at day 21 of age) compared to a placebo group receiving immunoglobulin with no reactivity against Campylobacter. While clearly preliminary, these results show that immunoglobulin can be produced from renewable sources at a price enabling passive immunization as a viable strategy for control of infectious diseases in the intensive animal production, with the potential to significantly reduce antibiotics consumption

Experience and usability of a website containing research-based knowledge and tools for pain self-management:a mixed-method study in people with high-impact chronic pain

OBJECTIVES: Smerteinfo.dk is a freely accessible Danish website containing research-based, up-to-date knowledge on chronic pain, written in lay language, with a focus on information, guidance and self-management tools, developed in collaboration between health professionals and persons with high-impact chronic pain. This mixed-method study explored experiences, perceived usability, and challenges of Smerteinfo among patients with high-impact chronic pain.METHODS: Semi-structured interviews enabling thinking-aloud and participant observation while using Smerteinfo were performed in 11 patients with high-impact chronic pain. Survey data were collected three months after being invited to use Smerteinfo among 200 patients on waiting-list at a Pain Center in Denmark.RESULTS: Three themes captured the depth and variation in patterns of experiences, usability and challenges using Smerteinfo during interviews: 1) Appreciated easy access to new knowledge yet strived for more personalized information, 2) Experienced incentives as well as challenges when navigating the website, and 3) Suggested earlier introduction to the website. Challenges concerned the unknown update frequency of the website, information consisting of mostly text and many links, lack of material to improve self-management and too general information. Survey data revealed that 87 % found the language in the articles easy to understand and 73 % could recognize themselves and their challenges in the articles. A proportion of the respondents reported improved understanding of their pain condition (56 %), improved coping (33 %), and that they had made changes in their everyday life after reading on the website (33 %).CONCLUSIONS: Patients with high-impact chronic pain found Smerteinfo valuable. The results suggest attention towards spreading knowledge of the website to general practitioners, who could introduce the site at an earlier stage of illness. Continuously improving the site and expand the applicable tools based on scientific evidence and in collaboration with end-users are crucial to ensure the usability of the website in the future.</p

Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark:The importance of initiation

Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study.Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression.Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72-0.87] to 0.89 95%CI [0.82-0.96] per already prescribed medicine), but once patients were in treatment, polypharmacy was not associated with recurrence of gaps in supply of medication, and polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI [0.86-1.00] to 0.96 95%CI [0.93-0.99] per prescribed medicine). Other identified risk factors for slow initiation, poor implementation, and discontinuation were diabetes duration, younger age, and Turkish/Pakistani origin.This study showed that a risk factor does not necessarily have the same association with all three elements of adherence (initiation, implementation and discontinuation), and that efforts supporting patients introduced to more complex drug combinations should be prioritized