Eradication of multi-resistant Salmonella typhimurium DT104 infections in 15 Danish swine herds

Multi-resistant Salmonella typhimurium DTI 04 (=DTI 04) was first isolated in United Kingdom in the 1980s. DT104 was isolated in Denmark for the first time in 1996 (1). Retrospective analysis of isolates detected DTI 04 in a Danish swine herd in 1991. The majority of the Danish isolates are characterized by being resistant to 5 frequently used antibiotics; ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracycline (ACStSuT), but isolates being resistant to e.g. flouroquinolones as well have been detected. DTI 04 is now known as an important and emerging pathogen in many countries (2, 3, 4, 5). DTI 04 has spread rapidly between animals within the herd, between herds and to other species (6). Salmonella \u27JYphimurium DTl 04 remains the second most common Salmonella in humans in England and Wales in 1997,95 pet. of the isolates were resistant to four or more antibiotics with the most common resistance pattern is that of ACStSuT (7). The described combination of the ability to spread rapidly and the multiresistance towards antibiotics used frequently in animals and humans implies that DTI 04 can be a serious problem for both animals and humans. By June 1999 DTI04has been detected in 16 swine herds, 12 combined swine and cattle herds and 2 cattle herds in Denmark. HumaneDTI04 cases have slightly increased in Denmark from 1997 to 1998. DTI04 now accounts for 13 pet. of Salmonella typhimurium phage types compared to 7 pet. in 1997. This increase is explained by the first community outbreak of DTI 04 in Denmark

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Subgroup analysis of telehealthcare for patients with chronic obstructive pulmonary disease: the cluster-randomized Danish Telecare North Trial

Flemming Witt Udsen,1 Pernille H Lilholt,2 Ole K Hejlesen,2 Lars H Ehlers1 1Danish Centre for Healthcare Improvements, Aalborg University, Aalborg, Denmark; 2Department of Health Science and Technology, Aalborg University, Aalborg, Denmark Purpose: Results from the Danish cluster-randomized trial of telehealthcare to 1,225 patients with chronic obstructive pulmonary disease (COPD), the Danish Telecare North Trial, concluded that the telehealthcare solution was unlikely to be cost-effective, by applying international willingness-to-pay threshold values. The purpose of this article was to assess potential sources of variation across subgroups, which could explain overall cost-effectiveness results or be utilized in future economic studies in telehealthcare research. Methods: First, the cost-structures and cost-effectiveness across COPD severities were analyzed. Second, five additional subgroup analyses were conducted, focusing on differences in cost-effectiveness across a set of comorbidities, age-groups, genders, resource patterns (resource use in the social care sector prior to randomization), and delivery sites. All subgroups were ­investigated post hoc. In analyzing cost-effectiveness, two separate linear mixed-effects models with treatment-by-covariate interactions were applied: one for quality-adjusted life-year (QALY) gain and one for total healthcare and social sector costs. Probabilistic sensitivity analysis was used for each subgroup result in order to quantify the uncertainty around the cost-effectiveness results. Results: The study concludes that, across the COPD severities, patients with severe COPD (GOLD 3 classification) are likely to be the most cost-effective group. This is primarily due to lower hospital-admission and primary-care costs. Telehealthcare for patients younger than 60 years is also more likely to be cost-effective than for older COPD patients. Overall, results indicate that existing resource patterns of patients and variations in delivery-site practices might have a strong influence on cost-effectiveness, possibly stronger than the included health or sociodemographic sources of heterogeneity. Conclusion: Future research should focus more on sources of heterogeneity found in the implementation context and the way telehealthcare is adopted (eg, by integrating formative evaluation into cost-effectiveness analyses). Trial registration: Clinicaltrials.gov, NCT01984840. Keywords: COPD, telemonitoring, telehealth, health economics, heterogeneity, Denmar

Eradication of multi-resistant Salmonella typhimurium DT104 infections in 15 Danish swine herds

Multi-resistant Salmonella typhimurium DTI 04 (=DTI 04) was first isolated in United Kingdom in the 1980s. DT104 was isolated in Denmark for the first time in 1996 (1). Retrospective analysis of isolates detected DTI 04 in a Danish swine herd in 1991. The majority of the Danish isolates are characterized by being resistant to 5 frequently used antibiotics; ampicillin, chloramphenicol, streptomycin, sulphonamides and tetracycline (ACStSuT), but isolates being resistant to e.g. flouroquinolones as well have been detected. DTI 04 is now known as an important and emerging pathogen in many countries (2, 3, 4, 5). DTI 04 has spread rapidly between animals within the herd, between herds and to other species (6). Salmonella 'JYphimurium DTl 04 remains the second most common Salmonella in humans in England and Wales in 1997,95 pet. of the isolates were resistant to four or more antibiotics with the most common resistance pattern is that of ACStSuT (7). The described combination of the ability to spread rapidly and the multiresistance towards antibiotics used frequently in animals and humans implies that DTI 04 can be a serious problem for both animals and humans. By June 1999 DTI04has been detected in 16 swine herds, 12 combined swine and cattle herds and 2 cattle herds in Denmark. HumaneDTI04 cases have slightly increased in Denmark from 1997 to 1998. DTI04 now accounts for 13 pet. of Salmonella typhimurium phage types compared to 7 pet. in 1997. This increase is explained by the first community outbreak of DTI 04 in Denmark.</p