Zoonoser hos sällskapsdjur

Our companion animals can, with or without symptoms, carry infectious agents which have a potential to induce diseases in man, so called zoonoses. An immune compromised person has an increased risk of becoming infected by various agents, and thus also has an increased risk to become infected by one's own companion animals. A study was carried out within the veterinary program at SLU, Sweden, based on a questionnaire answered by 31 physicians, 31 veterinarians and interviews of 30 immune compromised persons in Sweden. The study investigated the following questions: Which zoonoses do physicians and veterinarians consider to be the most important to inform immunecompromised persons about? How are immunecompromised persons being informed by their physicians about the risk of catching zoonoses from their companion animals? How are the owners of zoonosis-infected animals being informed by their veterinarians about zoonoses? Does veterinary medicine and human medicine communicate about zoonoses, in order to take the best care of immunecompromised persons in contact with animals? The results of our study imply that: - Physicians and veterinarians differ about which zoonoses immunecompromised persons should be informed about. - Only oral information is passed to immunecompromised persons and animal owners. - The communication between physicians and veterinarians regarding zoonoses, is limited. In this study there has also been compiled general guidance that may be useful for an immunecompromised person, to decrease the risk of becoming infected by his/her companion animals.Våra sällskapsdjur kan, med eller utan egna symtom, bära på smittämnen som har potential att framkalla sjukdom hos människa, så kallade zoonoser. Vid ett defekt immunförsvar hos människa finns en ökad risk att drabbas av infektioner av alla slag, och således också en ökad risk att smittas av sällskapsdjuren. Denna enkätstudie utfördes som en del av ett examensarbete inom veterinärprogrammet på Sveriges Lantbruksuniversitet (SLU). I studien ingick 31 veterinärer, 31 läkare och 30 personer med ett nedsatt immunförsvar. I studien söktes svar på följande frågor: Vilka zoonoser anser läkare och veterinärer vara de viktigaste som en immunsupprimerad person i Sverige bör informeras om? Hur informeras de immunsupprimerade personerna, av sina läkare, om smittriskerna från sällskapsdjuren? Hur informeras djurägare, till djur drabbade av ett zoonotiskt smittämne, av veterinären? Kommunicerar veterinär- och human medicinen om zoonoser för att optimera omhändertagandet av immunsupprimerade personer och zoonossmittade djur? Fynden i vår studie tyder på att: - Läkare och veterinärer har skilda uppfattningar om vilka zoonoser immunsupprimerade personer bör informeras om. - Informationen som ges till immunsupprimerade personer och djurägare enbart sker muntligt. - Kommunikationen mellan läkare och veterinärer angående zoonoser är begränsad. I arbetet är det också sammanställt en del allmänna råd som en immunsupprimerad person kan ha nytta av, för att minska risken att bli smittad av sitt sällskapsdjur

Lähikuva lähiöstä! – Itä-Porin kulttuurikartoitus ja toimenpidesuunitelma

Itä-Porin kerrostalolähiöt ovat Porin suurin lähiöalue. Ne syntyivät kasvavan ja teollistuvan kaupungin tarpeisiin ja edustavat aikansa aluerakentamista. Asukkaat ja rakennuskanta ovat vuosien varrella ikääntyneet, mutta alueiden rauhallisuutta ja luontoa arvostetaan. Lähiöiden asukastoiminta on monipuolista, Itä-Porista löytyy myös vireää taidetoimintaa ja arvokasta rakennusperintöä. Turun yliopiston maisemantutkimus on tehnyt Itä-Porin lähiöiden laajan kulttuurikartoituksen, jossa kerättiin tietoa asukasryhmistä, toiminnasta, ympäristöstä ja tarpeista. Tulosten pohjalta tuotettiin yhdessä asukkaiden, taiteilijaryhmä T.E.H.D.A.S. ry:n ja kaupungin edustajien kanssa toimenpidesuunnitelma lähiöiden kehittämiseksi. Itä-Porin tulevaisuudelle on tärkeää, että lähiöitä kehitetään tasapuolisesti muun kaupungin kanssa. Tähän vaaditaan kaikkien osapuolten panostusta ja yhteistyötä.</p

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations

Development and validation of a new clinical decision support tool to optimize screening for retinopathy of prematurity

Background/Aims Prematurely born infants undergo costly, stressful eye examinations to uncover the small fraction with retinopathy of prematurity (ROP) that needs treatment to prevent blindness. The aim was to develop a prediction tool (DIGIROP-Screen) with 100% sensitivity and high specificity to safely reduce screening of those infants not needing treatment. DIGIROP-Screen was compared with four other ROP models based on longitudinal weights. Methods Data, including infants born at 24–30 weeks of gestational age (GA), for DIGIROP-Screen development (DevGroup, N=6991) originate from the Swedish National Registry for ROP. Three international cohorts comprised the external validation groups (ValGroups, N=1241). Multivariable logistic regressions, over postnatal ages (PNAs) 6–14 weeks, were validated. Predictors were birth characteristics, status and age at first diagnosed ROP and essential interactions. Results ROP treatment was required in 287 (4.1%)/6991 infants in DevGroup and 49 (3.9%)/1241 in ValGroups. To allow 100% sensitivity in DevGroup, specificity at birth was 53.1% and cumulatively 60.5% at PNA 8 weeks. Applying the same cut-offs in ValGroups, specificities were similar (46.3% and 53.5%). One infant with severe malformations in ValGroups was incorrectly classified as not needing screening. For all other infants, at PNA 6–14 weeks, sensitivity was 100%. In other published models, sensitivity ranged from 88.5% to 100% and specificity ranged from 9.6% to 45.2%. Conclusions DIGIROP-Screen, a clinical decision support tool using readily available birth and ROP screening data for infants born GA 24–30 weeks, in the European and North American populations tested can safely identify infants not needing ROP screening. DIGIROP-Screen had equal or higher sensitivity and specificity compared with other models. DIGIROP-Screen should be tested in any new cohort for validation and if not validated it can be modified using the same statistical approaches applied to a specific clinical setting

Insurance data for research in companion animals: benefits and limitations

The primary aim of this article is to review the use of animal health insurance data in the scientific literature, especially in regard to morbidity or mortality in companion animals and horses. Methods and results were compared among studies on similar health conditions from different nations and years. A further objective was to critically evaluate benefits and limitations of such databases, to suggest ways to maximize their utility and to discuss the future use of animal insurance data for research purposes. Examples of studies on morbidity, mortality and survival estimates in dogs and horses, as well as neoplasia in dogs, are discussed

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Plant Population Dynamics and Conservation in Wooded Hay-Meadows – Effects of Intensified Management

The decrease in number and area of managed hay-meadows over the last century, in combination with the reduction of traditional management, threatens the biodiversity connected to these habitats. I experimentally examined how management intensity affected meadow characteristics and long-term population viability of three vascular plant species in wooded hay-meadows on the Swedish island of Gotland in the Baltic Sea. I discovered that intensified management (extra raking and/or extra mowing) reduced the amount of litter and biomass, even in well-managed meadows. The effects of intensified management on population growth rate varied among species. Deterministic demographic models revealed that intensified management increased population growth rate in Succisa pratensis. Stochastic modelling confirmed this; all meadows displayed larger projected population sizes 50 years into the future with intensified management. Polygala amarella responded with lower growth rates in raked plots, a consequence of the plant’s morphology, which makes it prone to being pulled out by raking. Hypochoeris maculata had population growth rates close to unity, and showed no response to an increase in management. Examination of the life-history characteristics of Polygala amarella showed that the species’ strategy is aimed at reproduction and fast growth, which is in contrast to the other two species, with their success relying on the survival of older plants. The species-specific responses to management show that several species should be considered when evaluating management practices for conservation of semi-natural grasslands. Furthermore, I suggest that data on stage distributions alone may not be sufficient for identifying threatened populations. In a study of artificial dispersal between meadows, I found that establishment was twice as successful for planted plug-plants compared to sown seeds. Both methods may be useful for introducing or augmenting meadow populations, depending on access to seed sources and possibilities to nurse plants. An electronic coordinate measurement device for gathering location data to be used in demographic studies was developed. In the field, the device proved to be a simple and reliable method for locating individuals in permanent plots

Plant Population Dynamics and Conservation in Wooded Hay-Meadows – Effects of Intensified Management

The decrease in number and area of managed hay-meadows over the last century, in combination with the reduction of traditional management, threatens the biodiversity connected to these habitats. I experimentally examined how management intensity affected meadow characteristics and long-term population viability of three vascular plant species in wooded hay-meadows on the Swedish island of Gotland in the Baltic Sea. I discovered that intensified management (extra raking and/or extra mowing) reduced the amount of litter and biomass, even in well-managed meadows. The effects of intensified management on population growth rate varied among species. Deterministic demographic models revealed that intensified management increased population growth rate in Succisa pratensis. Stochastic modelling confirmed this; all meadows displayed larger projected population sizes 50 years into the future with intensified management. Polygala amarella responded with lower growth rates in raked plots, a consequence of the plant’s morphology, which makes it prone to being pulled out by raking. Hypochoeris maculata had population growth rates close to unity, and showed no response to an increase in management. Examination of the life-history characteristics of Polygala amarella showed that the species’ strategy is aimed at reproduction and fast growth, which is in contrast to the other two species, with their success relying on the survival of older plants. The species-specific responses to management show that several species should be considered when evaluating management practices for conservation of semi-natural grasslands. Furthermore, I suggest that data on stage distributions alone may not be sufficient for identifying threatened populations. In a study of artificial dispersal between meadows, I found that establishment was twice as successful for planted plug-plants compared to sown seeds. Both methods may be useful for introducing or augmenting meadow populations, depending on access to seed sources and possibilities to nurse plants. An electronic coordinate measurement device for gathering location data to be used in demographic studies was developed. In the field, the device proved to be a simple and reliable method for locating individuals in permanent plots