Effect of different scenarios for selective dry-cow therapy on udder health, antimicrobial usage, and economics

The goal of dry-cow therapy (DCT) is to reduce the prevalence of intramammary infections (IMI) by eliminating existing IMI at drying off and preventing new IMI from occurring during the dry period. Due to public health concerns, however, preventive use of antimicrobials has become questionable. In this study, we evaluated the effects of 8 scenarios for selecting animals for DCT, taking into account variation in parity and cow-level somatic cell count (SCC) at drying off. The aim of this study was to evaluate udder health, antimicrobial usage, and economics at the herd level when using different scenarios for selecting cows for DCT. To enable calculation and comparison of the effects of different scenarios to select cows for DCT in an "average" herd, we created an example herd, with a virtual herd size of 100 dairy cows to be calving during a year. Udder health, antimicrobial usage, and economics were evaluated during the dry period and the first 100 d in lactation, the period during which the greatest effect of DCT is expected. This leads to an estimated 13,551 cow-days at risk during a year in a 100-cow dairy herd. In addition to a blanket DCT (BDCT) scenario, we developed 7 scenarios to select cows for DCT based on SCC. The scenarios covered a range of possible approaches to select low-SCC cows for DCT, all based on cow-level SCC thresholds on the last milk recording before drying off. The incidence rate of clinical mastitis in the example herd varied from 11.6 to 14.5 cases of clinical mastitis per 10,000 cow-days at risk in the different scenarios, and the prevalence of subclinical mastitis varied from 38.8% in scenario 1 (BDCT) to 48.3% in scenario 8. Total antimicrobial usage for DCT and clinical mastitis treatment varied over the scenarios from 1.27 (scenario 8) to 3.15 animal daily dosages (BDCT), leading to a maximum reduction in antimicrobial usage of 60% for scenario 8 compared with BDCT. The total costs for each of the scenarios showed little variation, varying from €4,893 for scenario 5 to €5,383 for scenario 8. The effect of selective DCT compared with BDCT on udder health, antimicrobial usage, and economics is influenced by the SCC criteria used to select cows for DCT. Scenario 2 resulted in the lowest increases in clinical and subclinical mastitis compared with BDCT. The greatest reduction in antimicrobial usage was achieved under scenario 8. From an economic perspective, lowest costs were achieved with scenario 5. Drying off dairy cows with antimicrobials has an effect on udder health, antimicrobial usage, and economics

Farmers' attitude toward the introduction of selective dry cow therapy

The attitude of Dutch dairy farmers toward selective dry cow treatment (SDCT) is unknown, although a favorable mindset toward application of SDCT seems crucial for successful implementation. Given the fact that blanket dry cow treatment has been strongly promoted until recently, the implementation of SDCT was expected to be quite a challenge. This study aimed to provide insight into the level of implementation of SDCT in 2013 in the Netherlands, the methods used by farmers for selection of cows for dry cow treatment (DCT), the relation between SDCT and udder health and antimicrobial usage (AMU) in 2013, and the mindset of farmers toward SDCT. In 2014, a questionnaire was conducted in a group of 177 herds included in a large-scale udder health study in 2013 and for which all clinical mastitis cases during this year were recorded. In addition, data on somatic cell count (SCC) parameters and AMU was available for these herds. The questionnaire included questions with regard to DCT with a special emphasis on farmers' attitude and mindset with regard to applying DCT in 2013. The data that were obtained from the questionnaire were combined with the data on clinical mastitis, SCC, and AMU. Descriptive statistics were used to evaluate the data and to study the association between DCT, udder health, and AMU. Univariable and multivariable logistic regression models with a logit link function were applied to evaluate potential associations between DCT and farmers' mindset. Selective DCT was taken up progressively by the farmers in our study, with 75% of them implementing SDCT in 2013. The main criterion used to select cows for DCT was the SCC history during the complete previous lactation. The herds were divided into 3 groups based on the percentage of cows dried off with antibiotics in 2013 as indicated by the farmers during interviews. The first group applied BDCT, and the herds for which SDCT was applied were split in 2 equally sized groups based on the median percentage of cows dried off with antibiotics (67%). The incidence rate of subclinical and clinical mastitis were comparable between the groups. Results of the multivariable model showed that 4 factors related to farmers' mindset were associated with the probability to apply SDCT: "financial consequences of SDCT," "uncertainty whether a cow will recover without antimicrobials," the statement "I do not have a problem with the (potential) negative consequences of SDCT," and the usage of internal teat sealants. Application of SDCT appeared to be associated with farmers' attitude. The mindset of farmers with respect to reduction of AMU and the implementation of SDCT was generally positive

Cost-Effectiveness of a Cardiac Rehabilitation Program Specifically Designed for Patients With Obesity Within the OPTICARE XL Randomized Controlled Trial

Objective: To assess the cost-effectiveness of a cardiac rehabilitation (CR) program specifically designed for cardiac patients with obesity vs standard CR. Design: Cost-effectiveness analysis based on observations in a randomized controlled trial. Setting: Three regional CR centers in the Netherlands. Participants: Cardiac patients (N=201) with obesity (BMI≥30 kg/m2) referred to CR. Interventions: Participants were randomized to a CR program specifically designed for patients with obesity (OPTICARE XL; N=102) or standard CR. OPTICARE XL included aerobic and strength exercise and behavioral coaching on diet and physical activity during 12 weeks, followed by a 9-month after-care program with “booster” educational sessions. Standard CR consisted of a 6- to 12-week aerobic exercise program, supplemented with cardiovascular lifestyle education. Main Outcome Measures: An economic evaluation, with an 18-month time horizon, in terms of quality-adjusted life years (QALYs) and costs from the societal perspective was performed. Costs were reported in 2020 Euros, discounted at a 4% annual rate, and health effects were discounted at a 1.5% annual rate. Results: OPTICARE XL CR and standard CR resulted in comparable health gain per patient (0.958 vs 0.965 QALYs, respectively; P=.96). Overall, OPTICARE XL CR saved costs (-€4542) compared with the standard CR group. The direct costs for OPTICARE XL CR were higher than for standard CR (€10,712 vs €9951), whereas indirect costs were lower (€51,789 vs €57,092), but these differences were not significant. Conclusions: This economic evaluation showed no differences between OPTICARE XL CR and standard CR in health effects and costs in cardiac patients with obesity

Left atrial strain predicts reverse remodeling after catheter ablation for atrial fibrillation

Objectives The purpose of this study was to assess left atrial (LA) strain during long-term follow-up after catheter ablation for atrial fibrillation and to find predictors for LA reverse remodeling. Background The association between LA reverse remodeling and improvement in LA strain after catheter ablation has not been investigated thus far. Methods In 148 patients undergoing catheter ablation for atrial fibrillation, LA volumes and LA strain were assessed with echocardiography at baseline and after a mean of 13.2 ± 6.7 months of follow-up. The study population was divided according to LA reverse remodeling at follow-up: responders were defined as patients who exhibited 15% or more reduction in maximum LA volume at long-term follow-up. Left atrial systolic (LAs) strain was assessed with tissue Doppler imaging. Results At follow-up, 93 patients (63%) were classified as responders, whereas 55 patients (37%) were nonresponders. At baseline, LAs strain was significantly higher in the responders as compared with the nonresponders (19 ± 8% vs. 14 ± 6%; p = 0.001). Among the responders, a significant increase in LAs strain was noted from baseline to follow-up (from 19 ± 8% to 22 ± 9%; p < 0.05), whereas no change was noted among the nonresponders. LAs strain at baseline was an independent predictor of LA reverse remodeling (odds ratio: 1.813; 95% confidence interval: 1.102 to 2.982; p = 0.019). Conclusions In the present study, 63% of the patients exhibited LA reverse remodeling after catheter ablation for atrial fibrillation, with a concomitant improvement in LA strain. LA strain at baseline was an independent predictor of LA reverse remodeling. © 2011 American College of Cardiology Foundation

Farmers' attitude toward the introduction of selective dry cow therapy

The attitude of Dutch dairy farmers toward selective dry cow treatment (SDCT) is unknown, although a favorable mindset toward application of SDCT seems crucial for successful implementation. Given the fact that blanket dry cow treatment has been strongly promoted until recently, the implementation of SDCT was expected to be quite a challenge. This study aimed to provide insight into the level of implementation of SDCT in 2013 in the Netherlands, the methods used by farmers for selection of cows for dry cow treatment (DCT), the relation between SDCT and udder health and antimicrobial usage (AMU) in 2013, and the mindset of farmers toward SDCT. In 2014, a questionnaire was conducted in a group of 177 herds included in a large-scale udder health study in 2013 and for which all clinical mastitis cases during this year were recorded. In addition, data on somatic cell count (SCC) parameters and AMU was available for these herds. The questionnaire included questions with regard to DCT with a special emphasis on farmers' attitude and mindset with regard to applying DCT in 2013. The data that were obtained from the questionnaire were combined with the data on clinical mastitis, SCC, and AMU. Descriptive statistics were used to evaluate the data and to study the association between DCT, udder health, and AMU. Univariable and multivariable logistic regression models with a logit link function were applied to evaluate potential associations between DCT and farmers' mindset. Selective DCT was taken up progressively by the farmers in our study, with 75% of them implementing SDCT in 2013. The main criterion used to select cows for DCT was the SCC history during the complete previous lactation. The herds were divided into 3 groups based on the percentage of cows dried off with antibiotics in 2013 as indicated by the farmers during interviews. The first group applied BDCT, and the herds for which SDCT was applied were split in 2 equally sized groups based on the median percentage of cows dried off with antibiotics (67%). The incidence rate of subclinical and clinical mastitis were comparable between the groups. Results of the multivariable model showed that 4 factors related to farmers' mindset were associated with the probability to apply SDCT: "financial consequences of SDCT," "uncertainty whether a cow will recover without antimicrobials," the statement "I do not have a problem with the (potential) negative consequences of SDCT," and the usage of internal teat sealants. Application of SDCT appeared to be associated with farmers' attitude. The mindset of farmers with respect to reduction of AMU and the implementation of SDCT was generally positive