Induction of oestrus in ewes of the rare Greek breeds Skopelos, Zakynthos, Kymi - Electrical resistance of cervical mucous

Σκοπός της μελέτης ήταν η αξιολόγηση της ανταπόκρισης στην αγωγή για πρόκληση οίστρου σε προβατίνες των φυλών Σκοπέλου, Ζακύνθου και Κύμης. Επίσης, διερευνήθηκε η δυνατότητα προσδιορισμού της ηλεκτρικής αντίστασης της τραχηλικής βλέννας για προσδιορισμό προβατίνων σε οίστρο. Η πρόκληση οίστρου έγινε με ενδοκολπική τοποθέτηση σπόγγων εμποτισμένων με 60 mg οξικής μεδροξυπρογεστερόνης επί 12 ημέρες [προβατίνες Σκοπέλου (n=17), Ζακύνθου (n=18), Κύμης (n=22)], ακολουθούμενη από ενδομυϊκή ένεση 400 IU ίππειας χοριακής γοναδοτροπίνης. Δείγματα αίματος, για προσδιορισμό της συγκέντρωσης οιστραδιόλης 17β και προγεστερόνης, συλλέχθηκαν 10 ημέρες πριν από την εισαγωγή των σπόγγων, κατά την εισαγωγή και την αφαίρεση αυτών και τον οίστρο. Η ηλεκτρική αντίσταση τραχηλικής βλέννας προσδιορίστηκε αμέσως μόλις οι προβατίνες ανιχνεύτηκαν σε οίστρο και, τελικά, πραγματοποιήθηκαν ελεύθερες οχείες. Η αναλογία προβατίνων που εκδήλωσαν οίστρο στα ζώα φυλής Ζακύνθου (100%), ήταν μεγαλύτερη από αυτήν στα ζώα φυλής Κύμης (64%) ή Σκοπέλου (78%). Το ποσοστό εγκυμοσύνης κυμάνθηκε από 50% (προβατίνες Κύμης) έως 67% (προβατίνες Σκοπέλου). Σε προβατίνες που κυοφόρησαν, η ηλεκτρική αντίσταση τραχηλικής βλέννας ήταν σημαντικά μικρότερη από αυτήν σε προβατίνες που δεν ήταν έγκυες τελικά. Λαμβάνονταν υπόψη τη συγκέντρωση της προγεστερόνης 10 ημέρες πριν την εισαγωγή των σπόγγων και κατά την εισαγωγή αυτών, οι προβατίνες της φυλής Κύμης βρίσκονταν σε άνοιστρο, ενώ αυτές των φυλών Σκοπέλου και Ζακύνθου βρίσκονταν σε οιστρική περίοδο. Η συγκέντρωση της προγεστερόνης κατά την αφαίρεση των σπόγγων και της οιστραδιόλης-17β κατά τον οίστρο, στις προβατίνες της φυλής Ζακύνθου που κυοφόρησαν, ήταν σημαντικά μεγαλύτερη από τις αντίστοιχες σε αυτές που δεν κυοφόρησαν. Επίσης, η συγκέντρωση της προγεστερόνης κατά την εισαγωγή των σπόγγων ήταν σημαντικά μεγαλύτερη σε όλες τις προβατίνες που κυοφόρησαν σε σύγκριση με αυτές που δεν κυοφόρησαν. Σημαντικές διαφορές παρατηρήθηκαν στις συγκεντρώσεις της προγεστερόνης και της οιστραδιόλης 17β μεταξύ των τριών φυλών, σε διάφορες φάσεις του πειραματισμού. Συμπεραίνεται ότι, οι προβατίνες των σπάνιων φυλών ανταποκρίθηκαν ικανοποιητικά στην αγωγή πρόκλησης οίστρου. Το ορμονικό πρότυπο των προβατίνων κατά την εισαγωγή των σπόγγων είναι σημαντικό για την κυοφορία. Η μέτρηση της ηλεκτρικής αντίστασης της τραχηλικής βλέννας θα μπορούσε να χρησιμοποιηθεί για την εντόπιση των προβατίνων που θα οχευθούν, ακόμα και στην περίπτωση που χρησιμοποιούνται κριοί για την ανίχνευση των οίστρων.Objective of the study was the investigation of the response of Skopelos, Zakynthos and Kymi ewes to oestrus induction treatment. Furthermore, feasibility of measuring electrical resistance of cervical mucus for oestrus detection was examined. Oestrus was induced by intravaginal insertion of sponges impregnated with 60 mg medroxyprogesterone acetate for 12 days [groups: Skopelos (n=17), Zakynthos (n=18), Kymi (n=22)], followed by intramuscular injection of 400 iu equine chorionic gonadotropins) at the time of withdrawal. Blood samples were collected 10 days before sponge insertion, at insertion and withdrawal and at oestrus for measurement of oestradiol 17-β and progesterone concentration. Electrical resistance of cervical mucus was measured after οestrus detection, then ewes were mated. Proportion of Zakynthos ewes (100%) in oestrus was greater than that of Kymi (64%) or Skopelos (78%) ewes. Pregnancy rate ranged from 50% (Kymi ewes) to 67% (Skopelos ewes). Electrical resistance of cervical mucus of ewes that conceived was significantly smaller than of those that did not. Based on results of progesterone blood concentration measurement 10 days before and at sponge insertion, only Kymi ewes were at full anoestrus, whilst Zakynthos and Skopelos ewes were in the breeding season. Progesterone blood concentration at sponge withdrawal and oestradiol 17-β blood concentration at oestrus were significantly greater in Zakynthos ewes that conceived compared to those in ewes that did not conceive. Furthermore, progesterone concentration at sponge insertion was significantly greater in all ewes that conceived compared to that in ewes that did not. There were significant differences in oestradiol-17β and progesterone blood concentrations among breeds and at the various time-points of blood collection. It is concluded that response of the above sheep breeds to oestrus induction was satisfactory. Hormonal status of ewes during sponge insertion is of importance for conception. Measurement of electrical resistance of cervical mucus could be useful for selection of ewes for mating, even if rams used to detect oestrous

A Cross-Sectional Survey on Medication Management Practices for Noncommunicable Diseases in Europe During the Second Wave of the COVID-19 Pandemic

Maintaining healthcare for noncommunicable diseases (NCDs) is particularly important during the COVID-19 pandemic; however, diversion of resources to acute care, and physical distancing restrictions markedly affected management of NCDs. We aimed to assess the medication management practices in place for NCDs during the second wave of the COVID-19 pandemic across European countries. In December 2020, the European Network to Advance Best practices & technoLogy on medication adherencE (ENABLE) conducted a cross-sectional, web-based survey in 38 European and one non-European countries. Besides descriptive statistics of responses, nonparametric tests and generalized linear models were used to evaluate the impact on available NCD services of the number of COVID-19 cases and deaths per 100,000 inhabitants, and gross domestic product (GDP) per capita. Fifty-three collaborators from 39 countries completed the survey. In 35 (90%) countries face-to-face primary-care, and out-patient consultations were reduced during the COVID-19 pandemic. The mean ± SD number of available forms of teleconsultation services in the public healthcare system was 3 ± 1.3. Electronic prescriptions were available in 36 (92%) countries. Online ordering and home delivery of prescription medication (avoiding pharmacy visits) were available in 18 (46%) and 26 (67%) countries, respectively. In 20 (51%) countries our respondents were unaware of any national guidelines regarding maintaining medication availability for NCDs, nor advice for patients on how to ensure access to medication and adherence during the pandemic. Our results point to an urgent need for a paradigm shift in NCD-related healthcare services to assure the maintenance of chronic pharmacological treatments during COVID-19 outbreaks, as well as possible future disasters

Tiotropium/Olodaterol Delays Clinically Important Deterioration Compared with Tiotropium Monotherapy in Patients with Early COPD:a Post Hoc Analysis of the TONADO® Trials

Introduction Since chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, a composite endpoint of clinically important deterioration (CID) may provide a more holistic assessment of treatment efficacy. We compared long-acting muscarinic antagonist/long-acting beta(2)-agonist combination therapy with tiotropium/olodaterol versus tiotropium alone using a composite endpoint for CID. CID was evaluated overall and in patients with low exacerbation history (at most one moderate exacerbation in the past year [not leading to hospitalisation]), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 patients and maintenance-naive patients with COPD. We assessed whether early treatment optimisation is more effective with tiotropium/olodaterol versus tiotropium in delaying and reducing the risk of CID. Methods Data were analysed from 2055 patients treated with either tiotropium/olodaterol 5/5 mu g or tiotropium 5 mu g (delivered via Respimat(R)) in two replicate, 52-week, parallel-group, double-blind studies (TONADO(R) 1/2). CID was defined as a decline of at least 0.1 L from baseline in trough forced expiratory volume in 1 s, increase from baseline of at least 4 units in St. George's Respiratory Questionnaire score, or moderate/severe exacerbation. Time to first occurrence of one of these events was recorded as time to first CID. Results Overall, treatment with tiotropium/olodaterol significantly increased the time to, and reduced the risk of, CID versus tiotropium (median time to CID 226 versus 169 days; hazard ratio [HR] 0.76 [95% confidence interval 0.68, 0.85]; P <0.0001). Significant reductions were also observed in patients with low exacerbation history (241 versus 170; HR 0.73 [0.64, 0.83]; P <0.0001), GOLD 2 patients (241 versus 169; 0.72 [0.61, 0.84]; P <0.0001) and maintenance-naive patients (233 versus 171; 0.75 [0.62, 0.91]; P = 0.0030). Conclusion In patients with COPD, including patients with low exacerbation history, GOLD 2 patients and maintenance-naive patients, tiotropium/olodaterol reduced the risk of CID versus tiotropium. These results demonstrate the advantages of treatment optimisation with tiotropium/olodaterol over tiotropium monotherapy. PLAIN LANGUAGE SUMMARY COPD is a complicated disease that deteriorates over time. Worsening of COPD is associated with the lungs working less effectively, a fall in quality of life and a rise in sudden flare-ups of the disease. In this study, we looked at lung function, quality of life and flare-ups together using a measure called "clinically important deterioration" (CID). We looked at 2055 people with COPD to compare the effects of taking two bronchodilators (tiotropium and olodaterol) against taking one bronchodilator (tiotropium alone). Bronchodilators are a type of inhaled medication that relax the muscles in the lungs and widen airways, making it easier to breathe. They have also been shown to reduce sudden flare-ups of COPD. Across a wide range of people with COPD, we found that treatment with tiotropium/olodaterol reduced the risk of a CID compared with tiotropium alone. This includes in those patients at an early stage of disease, who may benefit from finding the best treatment option for them as early as possible

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries

Background: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the “OTC SOCIOMED”, conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs’ intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries

A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries

Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.Public Health and primary carePrevention, Population and Disease management (PrePoD

A telehealth integrated asthma-COPD service for primary care: a proposal for a pilot feasibility study in Crete, Greece

<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) and asthma are considered underdiagnosed and misdiagnosed chronic diseases. In The Netherlands, a COPD-asthma telemedicine service has been developed to increase GPs' ability to diagnose and manage COPD and asthma. A telemedicine COPD-asthma service may benefit Greece as it is a country, partly due to its geography, that does not have easy access to pulmonologists.</p> <p>Findings</p> <p>Therefore, a pilot feasibility study has been designed in Greece in order to establish this telemedicine service. Ten rural practices, in the island of Crete, with an average population of 2000 patients per practice will pilot the project supported by three pulmonologists. This paper presents the translated interfaces, the flowcharts and the steps that are considered as necessary for this feasibility study in Crete, Greece.</p

Digital Health Europe (DHE) Twinning on Severe Asthma—Kick-off Meeting Report

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