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Infection of wheat by Fusarium species can lead to Fusarium Head Blight (FHB) and mycotoxin contamination, thereby reducing food quality and food safety, and leading to economic losses. Agronomic management through the implementation of various pre-harvest measures can reduce the probability of Fusarium spp. infection in the wheat field. To design interventions that could stimulate wheat farmers to (further) improve their agronomic management to reduce FHB, it is key to understand farmers' behaviour towards adapting their management. The aim of this paper was to understand the intention, underlying behavioural constructs, and beliefs of Dutch wheat farmers to adapt their agronomic management to reduce FHB and mycotoxin contamination in wheat, applying the Theory of Planned Behaviour (TPB). Data were collected from 100 Dutch wheat farmers via a questionnaire. The standard TPB analysis was extended with an assessment of the robustness of the belief results to account for the statistical validity of the analysis on TPB beliefs (i.e. to address the so-called expectancy-value muddle). Forty-six percent of the farmers had a positive intention to change their management in the next 5 years. The two behavioural constructs significantly related to this intention were attitude and social norm, whereas association with the perceived behavioural control construct was insignificant indicating that farmers did not perceive any barriers to change their behaviour. Relevant attitudinal beliefs indicated specific attributes of wheat, namely yield, quality and safety (lower mycotoxin contamination). This indicates that strengthening these beliefs—by demonstrating that a change in management will result in a higher yield and quality and lower mycotoxin levels—will result in a stronger attitude and, subsequently, a higher intention to change management. Interventions to strengthen these beliefs should preferably go by the most important referents for social norms, which were the buyers and the farmer cooperatives in this study. [ABSTRACT FROM AUTHOR]

The new Dutch guidelines on hereditary and familial ovarian carcinoma recommend genetic testing of all patients with epithelial ovarian cancer (EOC). With this study, we aimed to obtain insight into (1) the acceptance and timing of the offer of genetic counseling in women with EOC, (2) reasons for accepting or declining genetic counseling, and (3) psychological differences between women who did and did not have genetic counseling. A multicenter questionnaire survey was performed in patients with EOC in four Dutch oncology centers. The questionnaire addressed whether, how, and when genetic counseling was offered, women's arguments to accept or decline genetic counseling, and included the Cancer Worry Scale (CWS) and the Hospital Anxiety and Depression Scale (HADS). A total of 67 women completed the questionnaire, of which 43 had genetic counseling. Despite a wide variability in the timing of the offer of genetic counseling, 89% of the women were satisfied with the timing. No significant differences were found between the CWS and HADS scores for the timing of the offer of genetic counseling and whether or not women had genetic counseling. Taking the small sample size into account, the results tentatively suggest that genetic counseling may have limited impact on the psychosocial wellbeing of women with EOC. Therefore, we assume that implementation of the new guidelines offering genetic counseling to all patients with EOC will not cause considerable additional burden to these patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the short- and long-term effects of mindfulness-based stress reduction (MBSR) on the resulting quality of life, sexual functioning, and sexual distress after risk-reducing salpingo-oophorectomy (RRSO).Design: Randomised controlled trial.Setting: A specialised family cancer clinic of the university medical center Groningen.Population: Sixty-six women carriers of the BRCA1/2 mutation who developed at least two moderate-to-severe menopausal symptoms after RRSO.Methods: Women were randomised to an 8-week MBSR training programme or to care as usual (CAU).Main Outcome Measures: Change in the Menopause-Specific Quality of Life Questionnaire (MENQOL), the Female Sexual Function Index, and the Female Sexual Distress Scale, administered from baseline at 3, 6, and 12 months. Linear mixed modelling was applied to compare the effect of MBSR with CAU over time.Results: At 3 and 12 months, there were statistically significant improvements in the MENQOL for the MBSR group compared with the CAU group (both P = 0.04). At 3 months, the mean MENQOL scores were 3.5 (95% confidence interval, 95% CI 3.0-3.9) and 3.8 (95% CI 3.3-4.2) for the MBSR and CAU groups, respectively; at 12 months, the corresponding values were 3.6 (95% CI 3.1-4.0) and 3.9 (95% CI 3.5-4.4). No significant differences were found between the MBSR and CAU groups in the other scores.Conclusion: Mindfulness-based stress reduction was effective at improving quality of life in the short- and long-term for patients with menopausal symptoms after RRSO; however, it was not associated with an improvement in sexual functioning or distress.Tweetable Abstract: Mindfulness improves menopause-related quality of life in women after risk-reducing salpingo-oophorectomy. [ABSTRACT FROM AUTHOR]

Summary: The objective of this study was to identify factors that determine medical treatment seeking behaviour following potential rabies exposure after being bitten by a suspected dog and the likelihood of compliance to receive sufficient doses of post‐exposure prophylaxis after the visit to a health centre visit. A detailed survey based on case investigation was conducted on suspected rabid dog bite cases in three areas of Ethiopia. Two multivariable logistic regression models were created with a set of putative variables to explain treatment seeking and compliance outcomes. Based on the registered bite cases at each health centre and the set of unregistered bite cases derived by contact tracing, 655 bite victim cases were identified to have occurred between September 2013 and August 2014. Of these evaluated bite incidences, 465 cases were considered to have been caused by a potentially rabid dog. About 77% of these suspected rabid dog bite victims visited a health centre, while 57% received sufficient doses of PEP. The overall likelihood of seeking medical services following rabies exposure was higher for people bitten by dogs of unknown ownership, where the bite was severe, being bitten on the leg, spend of more than 100 USD per month and where the victim lived close to the nearest health centre, while the likelihood of receiving sufficient doses of PEP was sensitive to monthly spending and distance to health centre. However, the evaluated factors did only explain a part of the variation among the three districts. The district in which victims lived appeared to have a relevant influence on the likelihood of seeking medical treatment but did not improve the prediction on the likelihood of treatment compliance. Given the insights obtained from this study, improvements in the rural districts with regard to accessibility of post‐exposure prophylaxis delivering health centres in shorter distance could improve health seeking behaviour. In addition, in rural districts, majority of exposed persons who seek medical treatment tend to comply with treatment regimen, indicating that the promotion of medical treatment through awareness creation campaigns could be beneficial. [ABSTRACT FROM AUTHOR]

A dynamic deterministic simulation model was developed to determine the cost-effectiveness of different mass dog vaccination strategies against rabies in a dog population representative of a typical village on Flores Island. Cost-effectiveness was measured as public cost per averted dog-rabies case. Simulations started with the introduction of one infectious dog into a susceptible dog population of 399 dogs and subsequently ran for a period of 10 years. The base scenario represented a situation without any control intervention. Evaluated vaccination strategies were as follows: annual vaccination campaigns with short-acting vaccine (immunity duration of 52 weeks) (AV_52), annual campaigns with long-acting vaccine (immunity duration of 156 weeks) (AV_156), biannual campaigns with short-acting vaccine (BV_52) and once-in-2-years campaigns with long-acting vaccine (O2V_156). The effectiveness of the vaccination strategies was simulated for vaccination coverages of 50% and 70%. Cumulative results were reported for the 10-year simulation period. The base scenario resulted in three epidemic waves, with a total of 1274 dog-rabies cases. The public cost of applying AV_52 at a coverage of 50% was US$5342 for a village. This strategy was unfavourable compared to other strategies, as it was costly and ineffective in controlling the epidemic. The costs of AV_52 at a coverage of 70% and AV_156 at a coverage of 70% were, respectively, US$3646 and US$3716, equivalent to US$3.00 and US$3.17 per averted dog-rabies case. Increasing the coverage of AV_156 from 50% to 70% reduced the number of cases by 7% and reduced the cost by US$1452, resulting in a cost-effectiveness ratio of US$1.81 per averted dog-rabies case. This simulation model provides an effective tool to explore the public cost-effectiveness of mass dog vaccination strategies in Flores Island. Insights obtained from the simulation results are useful for animal health authorities to support decision-making in rabies-endemic areas, such as Flores Island. [ABSTRACT FROM AUTHOR]

The purpose of the study was to report the long-term outcome of unilateral implantation of a multifocal intraocular lens (IOL) in a pediatric cataract. This study was carried out at Tertiary Academic Ophthalmology Department, AMC, Amsterdam. This is a case report study of a 7-year-old child with a unilateral irradiation cataract, in whom an apodized diffractive multifocal IOL (SN6D3, Alcon) was implanted at the time of cataract surgery. During the follow-up period, visual acuity was preserved at logMAR −0.1; the child did not develop amblyopia. Binocular single vision was established. Few glistenings were seen on the IOL. The non-operated eye developed more myopia during the follow-up period than the multifocally implanted eye. Straylight was increased to log(s) 1.83. Patient and parents satisfaction were high. In selected cases, unilateral implantation of apodized diffractive multifocal IOLs leads to good long-term results in terms of visual acuity and patient satisfaction. No untoward effects were seen, including few glistenings on the IOL. Straylight is increased, but subjectively not disturbing. [ABSTRACT FROM AUTHOR]

This study aimed at determining the incidence, distribution, risk factors, and causal serotypes of foot and mouth disease ( FMD) outbreaks in Ethiopia based on 5 years of retrospective outbreak data (September 2007 until August 2012). District level outbreak data were collected from 115 randomly selected districts using a questionnaire administered to district animal health officers. The national incidence of FMD outbreaks during the study period was 1.45 outbreaks per five district years. Outbreaks were geographically widespread affecting all major regional states in the country and were more frequent in the central, southern, and southeastern parts of the country. Neither long-term nor seasonal trends were observed in the incidence of outbreaks. A mixed effects logistic regression analysis revealed that the type of production system (market oriented system versus subsistence systems), presence of a major livestock market and/or route, and adjacency to a national parks or wildlife sanctuary were found to be associated with increased risk of outbreaks in the districts. FMD virus serotypes O, A, SAT 2, and SAT 1 were identified as the causal serotypes of the outbreaks during the study period. Whereas O was the dominant serotype, SAT 2 was the serotype that showed increase in relative frequency of occurrence. The estimated incidence of outbreaks is useful in assessing the economic impacts of the disease, and the identified risk factors provide important knowledge to target a progressive FMD control policy for Ethiopia. [ABSTRACT FROM AUTHOR]

A framework for categorization of economic impacts of outbreaks of highly contagious livestock diseases ( HCLD) is presented. This framework interprets veterinary measures to control HCLD outbreaks with reference to economic definitions of costs and benefits, and the implications for value losses both for different stakeholders affected and society as a whole. Four cost categories are identified, that is virus control-related direct costs ( DC), spread prevention and zoning-related direct consequential costs ( DCC), market and price disruption-related costs during (indirect consequential costs, ICC) and after the outbreak (aftermath costs, AC). The framework is used to review existing literature on cost estimation for different stakeholders. This review shows considerable differences between studies, making comparison of results difficult and susceptible to misunderstanding. It is concluded that the framework provides a logical basis for all future analyses of the economic impacts of HCLD. [ABSTRACT FROM AUTHOR]

The cross-border region of the Netherlands ( NL) and the two German states of North Rhine Westphalia ( NRW) and Lower Saxony ( LS) is a large and highly integrated livestock production area. This region increasingly develops towards a single epidemiological area in which disease introduction is a shared veterinary and, consequently, economic risk. The objectives of this study were to examine classical swine fever ( CSF) control strategies' veterinary and direct economic impacts for NL, NRW and LS given the current production structure and to analyse CSF's cross-border causes and impacts within the NL- NRW- LS region. The course of the epidemic was simulated by the use of InterSpread Plus, whereas economic analysis was restricted to calculating disease control costs and costs directly resulting from the control measures applied. Three veterinary control strategies were considered: a strategy based on the minimum EU requirements, a vaccination and a depopulation strategy based on NL and GER's contingency plans. Regardless of the veterinary control strategy, simulated outbreak sizes and durations for 2010 were much smaller than those simulated previously, using data from over 10 years ago. For example, worst-case outbreaks (50th percentile) in NL resulted in 30-40 infected farms and lasted for two to four and a half months; associated direct costs and direct consequential costs ranged from €24.7 to 28.6 million and €11.7 to 26.7 million, respectively. Both vaccination and depopulation strategies were efficient in controlling outbreaks, especially large outbreaks, whereas the EU minimum strategy was especially deficient in controlling worst-case outbreaks. Both vaccination and depopulation strategies resulted in low direct costs and direct consequential costs. The probability of cross-border disease spread was relatively low, and cross-border spread resulted in small, short outbreaks in neighbouring countries. Few opportunities for further cross-border harmonization and collaboration were identified, including the implementation of cross-border regions (free and diseased regions regardless of the border) in case of outbreaks within close proximity of the border, and more and quicker sharing of information across the border. It was expected, however, that collaboration to mitigate the market effects of an epidemic will create more opportunities to lower the impact of CSF outbreaks in a cross-border context. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate differences in straylight between eyes implanted with a hydrophilic multifocal IOL (Seel-ens MF; Hanita Lenses, Hanita, Israel) and a hydrophobic multifocal IOL (SN6AD1; Alcon Laboratories, Inc., Fort Worth, TX). METHODS: In a prospective cohort study, routinely obtained straylight measurements (C-Quant; Oculus Op-tikgerate, Wetzlar, Germany) 3 months after standard phacoemulsification for either cataract or refractive lens procedures were compared. Patients were implanted with either the SeeLens MF IOL or the SN6AD1 IOL. Postoperative straylight values, visual acuity, and refractive outcomes were compared. RESULTS: The SeeLens MF IOL was implanted in 84 eyes and the SN6AD1 IOL in 79 eyes. The difference in straylight was 0.08 (P = .01), with the SeeLens MF IOL having less straylight. Postoperative CDVA was logMAR -0.03 ± 0.06 in the SeeLens MF group, and logMAR -0.02 ± 0.08 in the SN6AD1 group. Mean postoperative refraction was +0.01 ± 0.43 and +0.06 ± 0.35 D, respectively. CONCLUSIONS: The Seelens MF IOL showed a stray-light of log(s) 0.08 lower than the SN6AD1 IOL. In terms of spherical equivalent and visual acuity the lenses performed equally. More study will aid in understanding the causes and clinical impact of this difference. [ABSTRACT FROM AUTHOR]

The expertise and knowledge of veterinary advisors on improving animal health management is key towards a better herd health status. However, veterinary advisors are not always aware of the goals and priorities of dairy farmers. To dairy farmers animal health is only one aspect of farm management and resources may be allocated to other more preferred areas. Veterinary advisors may experience this as non-compliant with their advice. To explore the preferences of European Union (EU) organic dairy farmers for improved animal health management relative to other farm management areas an adaptive conjoint analysis (ACA) was performed. A total of 215 farmers participated originating from organic dairy farms in France (n=70), Germany (n=60), Spain (n=28) and Sweden (n=57). The management areas udder health and claw health represented animal health management whereas barn, calf and pasture management represented potential conflicting management areas. Results indicate that EU organic dairy farmers differ in their preferences for improved animal health management within the farming system. In general, improved calf management was the most preferred area and improved claw health management was found to be least preferred, the remaining areas were of intermediate interest. Cluster analyses on claw health measures and udder health measures resulted in respectively seven and nine distinct preference profiles. The results indicate a high degree of variation in farmers’ preference, which cannot be explained by the typical herd characteristics. With the individual preferences revealed by ACA, a veterinary advisor can now find out whether his intended advice is directed at a favourable or unfavourable management area of the farmer. If the latter is the case the veterinarian should first create awareness of the problem to the farmer. Insights in individual farmers preferences will allow veterinary advisors to better understand why farmers were incompliant with their advice and improve their advice by showing, for example, the potential benefits of their advice. [ABSTRACT FROM PUBLISHER]

The objectives of this study were to explore farmers’ intentions to implement foot and mouth disease (FMD) control in Ethiopia, and to identify perceptions about the disease and its control measures that influence these intentions using the Health Belief Model (HBM) framework. Data were collected using questionnaires from 293 farmers in three different production systems. The influence of perceptions on the intentions to implement control measures were analyzed using binary logistic regression. The effect of socio-demographic and husbandry variables on perceptions that were found to significantly influence the intentions were analyzed using ordinal logistic regression. Almost all farmers (99%) intended to implement FMD vaccination free of charge. The majority of farmers in the pastoral (94%) and market oriented (92%) systems also had the intention to implement vaccination with charge but only 42% of the crop-livestock mixed farmers had the intention to do so. Only 2% of pastoral and 18% of crop-livestock mixed farmers had the intention to implement herd isolation and animal movement restriction continuously. These proportions increased to 11% for pastoral and 50% for crop-livestock mixed farmers when the measure is applied only during an outbreak. The majority of farmers in the market oriented system (>80%) had the intention to implement herd isolation and animal movement restriction measure, both continuously and during an outbreak. Among the HBM perception constructs, perceived barrier was found to be the only significant predictor of the intention to implement vaccination. Perceived susceptibility, perceived benefit and perceived barrier were the significant predictors of the intention for herd isolation and animal movement restriction measure. In turn, the predicting perceived barrier on vaccination control varied significantly with the production system and the age of farmers. The significant HBM perception predictors on herd isolation and animal movement restriction control were significantly influenced only by the type of production system. The results of this study indicate that farmers’ intentions to apply FMD control measures are variable among production systems, an insight which is relevant in the development of future control programs. Promotion programs aimed at increasing farmers’ motivation to participate in FMD control by charged vaccination or animal movement restriction should give attention to the perceived barriers influencing the intentions to apply these measures. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported a breast cancer (BC) risk reduction of approximately 50% after risk-reducing salpingo-oophorectomy (RRSO) in BRCA1/2 mutation carriers, but may have been subject to several types of bias. The purpose of this nationwide cohort study was to assess potential bias in the estimated BC risk reduction after RRSO. Methods: We selected BRCA1/2 mutation carriers from an ongoing nationwide cohort study on Hereditary Breast and Ovarian Cancer in the Netherlands (HEBON). First, we replicated the analytical methods as previously applied in four major studies on BC risk after RRSO. Cox proportional hazards models were used to calculate hazard ratios and conditional logistic regression to calculate odds ratios. Secondly, we analyzed the data in a revised design in order to further minimize bias using an extended Cox model with RRSO as a time-dependent variable to calculate the hazard ratio. The most important differences between our approach and those of previous studies were the requirement of no history of cancer at the date of DNA diagnosis and the inclusion of person-time preceding RRSO. Results: Applying the four previously described analytical methods and the data of 551 to 934 BRCA1/2 mutation carriers with a median follow-up of 2.7 to 4.6 years, the odds ratio was 0.61 (95% confidence interval [CI] = 0.35 to 1.08), and the hazard ratios were 0.36 (95% CI = 0.25 to 0.53), 0.62 (95% CI = 0.39 to 0.99), and 0.49 (95% CI = 0.33 to 0.71), being similar to earlier findings. For the revised analysis, we included 822 BRCA1/2 mutation carriers. After a median follow-up period of 3.2 years, we obtained a hazard ratio of 1.09 (95% CI = 0.67 to 1.77). Conclusion: In previous studies, BC risk reduction after RRSO in BRCA1/2 mutation carriers may have been overestimated because of bias. Using a design that maximally eliminated bias, we found no evidence for a protective effect. [ABSTRACT FROM AUTHOR]

This paper analyses the potential gains and the main challenges for increased cross-border collaboration in the control of highly contagious livestock diseases in regions with cross-border reliance on production and consumption of livestock commodities. The aim of this intensification of cross-border collaboration is to retain the economic advantages of cross-border trade in livestock and livestock commodities while maintaining a low risk of highly contagious livestock diseases. From these two foci, possibilities for future policy making with respect to highly contagious livestock diseases are discussed: peacetime cross-border cooperation to improve the cost-effectiveness of routine veterinary measures and crisis time cross-border harmonization of current disease control strategies. A general disease management framework was used to describe the way in which these two fields are related to and affect the epidemiological system and, consequently, how they impact the stakeholders. In addition to this framework, the importance of a good understanding of influencing factors, that is, the production structure of livestock, was stressed because these factors are important determinants of the frequency and magnitude of highly contagious livestock diseases and their economic impact. The use of the suggested integrated approach was illustrated for the extended cross-border region of the Netherlands and Germany, that is, North Rhine Westphalia and Lower Saxony. For this region, current difficulties in cross-border trade in livestock and livestock commodities and possibilities for future cross-border collaboration were examined. The concepts and ideas presented in this paper should foster future development of cross-border collaboration in animal health control. [ABSTRACT FROM AUTHOR]

A combined epidemiological-economic modelling approach was used to analyse strategies for highly pathogenic avian influenza ( HPAI) control for the Netherlands. The modelling framework used was Inter Spread Plus ( ISP), a spatially based, stochastic and dynamic simulation model. A total of eight control strategies were analysed, including pre-emptive depopulation and vaccination strategies. The analysis was carried out for three different regions in the Netherlands: high-, medium- and low-density areas ( HDA, MDA and LDA, respectively). The analysis included the veterinary impact (e.g. number of infected premises and duration), but was particularly focused on the impact on direct costs ( DC) and direct consequential costs. The efficient set of control strategies for HDA and MDA included strategies based on either pre-emptive depopulation only or combined vaccination and pre-emptive depopulation: D2 (pre-emptive depopulation within a radius of 2 km), RV3 + D1 (ring vaccination within a radius of 3 km and additional pre-emptive depopulation within a radius of 1 km) and PV + D1 (preventive vaccination in non-affected HDAs and pre-emptive depopulation within a radius of 1 km in the affected HDA). Although control solely based on depopulation in most cases showed to be effective for LDA, pre-emptive depopulation showed to have an additional advantage in these areas, that is, prevention of 'virus jumps' to other areas. The pros and cons of the efficient control strategies were discussed, for example, public perception and risk of export restrictions. It was concluded that for the Netherlands control of HPAI preferably should be carried out using strategies including pre-emptive depopulation with or without vaccination. Particularly, the short- and long-term implications on export, that is, indirect consequential costs ( ICC) and aftermath costs of these strategies, should be analysed further. [ABSTRACT FROM AUTHOR]

Economic analysis of control strategies for contagious diseases is a necessity in the development of contingency plans. Economic impacts arising from epidemics such as highly pathogenic avian influenza ( HPAI) consist of direct costs ( DC), direct consequential costs ( DCC), indirect consequential costs ( ICC) and aftermath costs ( AC). Epidemiological models to support economic analysis need to provide adequate outputs for these critical economic parameters. Of particular importance for DCC, ICC and AC is the spatial production structure of a region. Spatial simulation models are therefore particularly suited for economic analysis; however, they often require a large number of parameters. The aims of this study are (i) to provide an economic rationale of epidemiological modelling in general, (ii) to provide a transparent description of the parameterization of a spatially based epidemiological model for the analysis of HPAI control in the Netherlands and (iii) to discuss the validity and usefulness of this model for subsequent economic analysis. In the model, HPAI virus transmission occurs via local spread and animal movements. Control mechanisms include surveillance and tracing, movement restrictions and depopulation. Sensitivity analysis of key parameters indicated that the epidemiological outputs with the largest influence on the economic impacts (i.e. epidemic duration and number of farms in the movement restriction zone) were more robust than less influential indicators (i.e. number of infected farms). Economically relevant outputs for strategy comparison were most sensitive to the relative role of the different transmission parameters. The default simulation and results of the sensitivity analysis were consistent with the general outcomes of known HPAI models. Comparison was, however, limited due to the absence of some economically relevant outputs. It was concluded that the model creates economically relevant, adequate and credible output for subsequent use in economic analysis. A detailed economic analysis is presented in a subsequent article. [ABSTRACT FROM AUTHOR]

International agreements on plant health and trade require that regulating a pest should be justified by economic impact assessment. Economic impact assessments are usually qualitative, weakening the objective and transparency of the regulation decision. This study assessed the potential economic impacts of the invasion of the plant pathogenic bacterium ' Candidatus Liberibacter solanacearum' into the European Union in order to economically justify a decision on its quarantine status. Direct economic impacts resulting from yield loss in potato and tomato were computed using partial budgeting at a regional scale, while total economic impacts on the potato and tomato markets were computed using partial equilibrium modelling at the EU scale. Annual direct impacts at the most likely infestation level were estimated at €222 m for the whole EU. Uncertainty analysis showed a distribution of foreseeable annual impacts with a 5th percentile of €192 m, and a 95th percentile of €512 m. Increased market prices of potato and tomato resulting from reduced supply were found to increase profits for non-infested producers and to compensate in part for the production losses of infested producers, with consumers paying for this mitigation of impacts on producers. The expected negative impact on societal welfare at the most likely infestation level is less than the estimated direct impacts, viz. €114 m/year. The potential economic impacts of ' Ca. L. solanacearum' in the European Union are demonstrably of major importance. Therefore, a decision to categorize this organism as a quarantine pest is supported. [ABSTRACT FROM AUTHOR]

In the Netherlands, outbreaks of Aujeszky's Disease (AD) are controlled by vaccination and movement restriction zones (MRZ). Although this strategy avoids the socio-ethical concerns associated with pre-emptive slaughter, it can easily result in animal welfare problems and negative economic consequences. These arise because movement restrictions result in surpluses of live (vaccinated) piglets on farms. The aim is to provide insight into the development of these surpluses and its impact and to describe how measures that allow early transportation of pigs under certain conditions and to specific destinations (channelling) could reduce these problems. For the analysis, a deterministic simulation model was developed, which calculates surpluses of piglets at multiplier farms during AD outbreaks. This is performed on a weekly basis for two areas (with and without piglet surplus), three outbreak durations (minimum, moderate and long) and three strategies for movement restrictions (strict, transports within the MRZ allowed and transports outside the MRZ allowed). The results show that in case of complete movement restrictions, surpluses of piglets varying in age and vaccination status will quickly arise. These surpluses are larger for longer epidemics and can become as large as 180-340 thousand piglets (45-75% of weekly domestic production) for moderate and long epidemics, respectively. Implementation of channelling strategies that allow earlier transportation within the MRZ can reduce surpluses by about 50% to 100-150 thousand piglets maximum. Strategies that also allow transportation outside the MRZ can reduce surpluses even further to below 100 thousand piglets. It was concluded that channelling of live piglets during AD outbreaks results in a drastic reduction of problems with accommodating ready-for-transport piglets. Moreover, it reduces shortages during movement restrictions and peak supply immediately after removing the restrictions. Channelling could therefore be an important instrument to reduce the economic and animal welfare impacts of containment measures. [ABSTRACT FROM AUTHOR]

The costs and reliability of two electronic identification and registration (I&R) systems for sheep and goats were estimated and compared to the current I&R system in the Dutch sheep and goat sectors. In the current system (farm individual registration or FIR), animals are identified with ear tags with an individual animal number, unique farm number and registered on-farm. In the central individual registration (CIR) system animals are identified with electronic ear tags and registered individually in a central database. In the central group registration (CGR) system animals are identified with electronic ear tags and registered individually on-farm, while group movements are registered in a central database. The net costs for the FIR system were 2.6 and 1.2 million Euros per year for sheep and goats, respectively. These net costs increased to a total of 11.8 and 6.0 million Euros per year for the CIR system and to 13.5 and 6.8 million Euros per year for the CGR system. The expected percentages of incorrect registrations were equal to an average of 7.2% and 3.4% for FIR and CIR, respectively, and a lower limit of 7.6% for CGR. [ABSTRACT FROM AUTHOR]

Copyright of Tijdschrift voor Medisch Onderwijs is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Tijdschrift voor Medisch Onderwijs is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The use of punctal plugs in the treatment of dry eyes is well established. Anophthalmic patients have less tears in the anophthalmic socket in comparison to their normal side, due to an absent corneal reflex (Lee & Elsie, 1981a,b). Many of those patients complain of dry eye symptoms, even when they are treated with tear replacement therapy. The authors wished to examine whether they could improve their dry socket complaints with punctal plugs. Purpose: To evaluate the clinical efficacy and tolerability of punctal plug (Smart Plugs®) insertion in anophthalmic patients with symptoms of dry eye. Patients and methods: Interventional case series. Fifteen anophthalmic patients with dry eye symptoms, a Schirmer test of less than 3 mm and an open lacrimal passage were examined before and after insertion of punctal plugs. The patients were asked for their subjective evaluation of the treatment and were examined to evaluate the change. Schirmer tests were compared. Bacterial cultures were taken at both visits. Results: Schirmer results of less than 3 mm in the anophthalmic socket were obtained in 75% of patients with dry eyes symptoms; 87% of patients in whom punctal plugs were inserted reported an improvement in dry eye sensation. More than half of the patients demonstrated less discharge (p ≤ 0.05). Schirmer tests improved from 1.4 mm to 1.9 mm (p ≤ 0.05). Patients with a Schirmer outcome of 2 mm or more tended to have less pathogenic bacterial cultures (p = 0.11). Conclusion: Punctal plugs improve the symptoms and signs of dry socket. Punctal plugs seem to reduce the pathogenic bacterial growth in the anophthalmic socket. [ABSTRACT FROM AUTHOR]

Since 1995, the Dutch potato production chain has been hit by several outbreaks of brown rot, a quarantine disease caused by Ralstonia solanacearum race 3, biovar 2. To avoid establishment of brown rot in the potato production chain and avert the consequences on potato export, the Dutch government has implemented an intensive and costly control policy. It is unknown whether this policy is cost-effective. A bio-economic model was developed that can be used to simulate the effect of a control policy on the epidemiology and economic consequences of brown rot in the Dutch potato production chain. Two applications of this model are presented, based on which the potential contribution of the model to cost-effective control of brown rot is discussed. [ABSTRACT FROM AUTHOR]

BRCA1/2 mutation carriers are offered gynaecological screening with the intention to reduce mortality by detecting ovarian cancer at an early stage. We examined compliance and efficacy of gynaecological screening in BRCA1/2 mutation carriers. In this multicentre, observational, follow-up study we examined medical record data of a consecutive series of 888 BRCA1/2 mutation carriers who started annual screening with transvaginal ultrasonography and serum CA125 between 1993 and 2005. The women were annually screened for 75% of their total period of follow-up. Compliance decreased with longer follow-up. Five of the 10 incident cancers were interval tumours, diagnosed in women with a normal screening result within 3–10 months before diagnosis. No difference in stage distribution between incident screen-detected and interval tumours was found. Eight of the 10 incident cancers were stage III/IV (80%). Cancers diagnosed in unscreened family members had a similar stage distribution (77% in stage III/IV). The observed number of cases detected during screening was not significantly higher than expected (Standardized Incidence Ratio (SIR): 1.5, 95% confidence interval: 0.7–2.8). For the subgroup that was fully compliant to annual screening, a similar SIR was found (1.6, 95% confidence interval: 0.5–3.6). Despite annual gynaecological screening, a high proportion of ovarian cancers in BRCA1/2 carriers are interval cancers and the large majority of all cancers are diagnosed in advanced stages. Therefore, it is unlikely that annual screening will reduce mortality from ovarian cancer in BRCA1/2 mutation carriers.British Journal of Cancer (2007) 96, 1335–1342. doi:10.1038/sj.bjc.6603725 www.bjcancer.com Published online 10 April 2007 [ABSTRACT FROM AUTHOR]

Only a small percentage of Graves’ ophthalmopathy (GO) patients develop optic neuropathy with impending loss of visual acuity. Therapy with methylprednisolone pulses is the treatment of first choice in severe and active GO patients. When the effect is insufficient, patients are usually treated with surgical decompression. We investigated whether surgery could become the first-line treatment, thus preventing treatment with steroids. We performed a randomized trial in 15 patients with very active GO and optic neuropathy. Six patients were treated with surgical decompression, and nine with methylprednisolone i.v. pulses for 2 weeks, followed by oral prednisone for 4 months. The primary outcome was determined by changes in visual acuity. If the eye disease deteriorated despite treatment or did not improve sufficiently, patients were switched to the other treatment arm. The severity and activity of GO in both groups were similar at baseline. The Clinical Activity Score (CAS) was 6·3 ± 0·8 in the surgical group vs. 6·0 ± 0·5 in the steroids group and the Total Eye Score was 24 ± 6 vs. 25 ± 6. In the surgery group, 5/6 patients (82%) did not respond because of insufficient improvement in vision ( n = 3) or persistent chemosis ( n = 2), and all needed further immunosuppression. In the steroids group, 4/9 patients (45%) did not improve in visual acuity ( P = 0·132 vs. surgery group), and these needed decompressive surgery. All patients in whom therapy failed were switched to the other treatment arm and visual acuity improved in almost all patients. Visual acuity improved from 0·36 (0·02–0·40) to 0·90 (0·63–1·0) in the surgery group and from 0·50 (0·32–0·63) to 0·75 (0·32–1·0) in the steroids group at 52 weeks. At long-term follow-up in the surgery group 3/6 patients required squint surgery and 5/9 patients in the steroids group. Eyelid surgery was performed in 5/6 patients in the surgery group and in 4/9 patients in the steroids group. Immediate surgery does not result in a better outcome and therefore methylprednisolone pulse therapy appears to be the first-choice therapy. [ABSTRACT FROM AUTHOR]

AIM The purpose of this study was to test the reliability of an exophthalmometer commonly used in the Netherlands; to determine the exophthalmometry value distribution with this instrument and to assess the upper exophthalmometry limits of normal in a healthy, adult, Caucasian, Dutch population. Furthermore, to assess the effects of gender and age on exophthalmometry readings in this group and in a group of Graves' patients by comparing healthy, adult, Caucasian, Dutch individuals with adult, Caucasian, Dutch Graves' patients. METHODS To test the reliability of our Hertel exophthalmometer, we determined the interobserver variation between two observers by measuring 160 eyes in healthy, adult, Caucasian, Dutch females and males (10 females and 10 males in each decade between 20 and 60 years of age). These data were also used for the assessment of the Hertel value distribution and for defining the upper limits of normal in these individuals by logistic regression analysis. The effects of disease, age and gender were established using these data plus data of a retrospective study of 393 adult, Caucasian, Dutch females (n = 294) and males (n = 99) with Graves' orbitopathy in whom Hertel values were measured with the same exophthalmometer. RESULTS Exophthalmometry using an Hertel exophthalmometer appeared reliable (Pearson correlation coefficient for interobserver variation 0.89; 96% of the Hertel values measured by two observers were within the limits (of 2 mm) of agreement). Hertel values usually show a normal distribution in healthy individuals and in Graves' patients and are sex- and age-dependent, but there was no dependence on age in this small series in adults. Logistic regression analysis revealed an upper limit of normal of 16 mm in females and 20 mm in males in our group, using the exophthalmometer described. CONCLUSIONS Exophthalmometry is reliable and absolute measurement of proptosis is feasible. International standardization of Hertel exophthalmometry is required in order to compare exophthalmometry data in the literature reliably. [ABSTRACT FROM AUTHOR]

Tamoxifen is a nonsteroidal anti-oestrogen with gynaecological side-effects. Only recently, ovarian cyst formation during tamoxifen treatment has been reported. The present study aimed to evaluate patient-related parameters that determine ovarian cyst formation in women using tamoxifen for breast cancer. A cross-sectional study was performed in 142 breast cancer patients using tamoxifen. Forty-five patients were also examined prior to tamoxifen treatment. Gynaecological assessment, transvaginal ultrasonography (TVU) and serum oestradiol (E[SUB2]) and follicle stimulating hormone (FSH) analysis were performed. Follow-up assessments were performed twice a year. Uni- or bilateral ovarian cysts were detected by TVU in 24 tamoxifen-using patients and in one patient before tamoxifen treatment. Multiple regression analysis showed that cyst development is related (multiple R = 0.73) to high E[SUB2] (P < 0.001), younger age (P < 0.001) and absence of high-dose chemotherapy (P = 0.007). Patients with ovarian cysts had higher serum E[SUB2] levels compared to patients without cysts (1.95 vs 0.05 nmol l[SUP-1] ;P < 0.001). All (patients after high-dose chemotherapy or older than 50 years had E[SUB2] (< 0.10 nmol l[SUP-1] and/or amenorrhoea > 1 year and did not develop ovarian cysts. Patients still having a menstrual cycle during tamoxifen had a high chance (81%) of developing ovarian cysts. Breast cancer patients receiving tamoxifen only develop ovarian cysts if their ovaries are able to respond to FSH stimulation as shown by E[SUB2] production. [ABSTRACT FROM AUTHOR]

In various autoimmune diseases circulating levels of soluble IL-2 receptor (slL-2R) seem to be related to disease activity. Because reliable parameters of disease activity in Graves' ophthalmopathy are lacking. we measured slI.-2R levels in 47 patients with this disorder. The patients had Graves' disease, but no other immune-mediated diseases, had not yet received specific treatment be their ophthalmopathy and were cuthyroid during the entire study period. Twenty-nne of the 47 patients (45%) had sIL-2R values above the upper normal limit of 650 U/ml. as established in 20 healthy controls. There were no differences between patients with normal (median 469. range 280-644 U/mI) and elevated (median 946, range 678-1588 U/mI) sIL-2R levels regarding duration or severity of the eye disease (a.c assessed clinically from the total eye score). However, patients with severely enlarged eye muscles had higher sIL-2R values than patients with less severely enlarged eye muscles on CT scan. Patients with elevated slL-2R tended to have a higher response rate (7lY)to a 3-month course of prednisone, than those with normal levels (46%; P <0.81). Since a successful outcome of prednisone treatment might he representative for disease activity, the elecated slL-2R levels seem It) reflect active inflammation. Although the practical relevance of this finding in individual patients is limited, it underscores the importance of cell-mediated immune responses in this thyroid-related eye disease. [ABSTRACT FROM AUTHOR]

A factor which inhibits the random migration of monocytes in vitro was found in the serum of nearly half of Graves' ophthalmopathy patients. This factor was found in serum of only 4% of the healthy controls. When the Graves' ophthalmopathy patients were subdivided, on clinical criteria (pain, redness, swelling and impaired function), into patients with active disease and patients with inactive disease, the serum factor was found in 61% of the patients with active inflammatory disease and only in 14% of the patients with inactive disease. Furthermore this factor was also found in the serum of patients with an acute episode of uveitis, suggesting that it may be a useful marker for assessment of a localized inflammatory process. [ABSTRACT FROM AUTHOR]

AIMS/BACKGROUND: In Graves' ophthalmopathy the increase in volume of intraocular muscles and fat will cause elevated intraorbital pressure. In order to investigate the pressure levels involved, intraorbital pressure, or retrobulbar pressure (RBP) was measured continuously in orbits of patients with Graves' ophthalmopathy during surgical decompression. METHODS: Retrobulbar pressure was measured before and during surgical decompression using an intraorbitally applied pressure transducer. RESULTS: In eight patients with dysthyroid optic neuropathy (DON) RBPs between 17 and 40 mm Hg were recorded. At the end of the surgical procedure the mean RBP was reduced from 28.7 mm Hg to 18.7 mm Hg, the decrease ranging from 8 to 12 mm Hg, which showed a high correlation with the starting pressures (p < 0.001). In two cases without DON, pressures were 11 and 9 mm Hg. Forces exerted by spatula manipulation usually resulted in a RBP level of more than 70 mm Hg. CONCLUSIONS: This study shows that RBPs are markedly elevated in Graves' ophthalmopathy and that surgical decompression can result in a significant reduction in the intraorbital pressure. Optic nerve dysfunction in Graves' ophthalmopathy may not be caused exclusively by the direct pressure of swollen extraocular muscles upon the optic nerve, but also by a raised RBP. It is hypothesised that the damage inflicted upon the optic nerve can be caused in consequence by RBP induced incarceration of the nerve, compressed by surrounding periosteal lined orbital fat bulging posteriorly into the entrance of the optic canal. [ABSTRACT FROM PUBLISHER]

Contrast sensitivity function was measured by a computer automated method on 38 eyes with dysthyroid optic neuropathy and 34 eyes with Graves' ophthalmopathy only. The results were compared with 74 healthy control eyes. Disturbances of contrast sensitivity functions were found in both groups when compared with controls. The eyes affected with dysthyroid optic neuropathy showed pronounced loss of contrast sensitivity in the low frequency range, which facilitates differentiation between the two groups. [ABSTRACT FROM PUBLISHER]

The efficacy of scleral grafts for eyelid lengthening in patients with thyroid related upper and/or lower lid retraction was evaluated in 62 consecutive patients with Graves' ophthalmopathy who underwent lid surgery in the last 3.5 years. Seventy-eight upper and 30 lower lids were lengthened by scleral interposition. A good or acceptable result was achieved in 50% of all operated upper lids after one procedure. This percentage increased to 75% after a second and to 77% after a third procedure. Persistent temporal retraction and nasal overcorrection were the major complications. In lower lid lengthening the success percentage was 90% after one operation. We conclude that scleral grafting for upper eyelid lengthening has no distinct advantage in comparison with other lengthening techniques. Scleral implants to lengthen lower lids are very effective. [ABSTRACT FROM PUBLISHER]

Patients with serious inflammatory Graves' ophthalmopathy should be treated with anti-inflammatory drugs or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately. It is often difficult, however, to distinguish inflammatory from non-inflammatory Graves' disease. We therefore present a simple clinical classification here to differentiate between these two conditions. This classification is based on the classical signs of inflammation--pain, redness, swelling, and impaired function. After two consecutive clinical examinations an 'activity score' can be determined, ranging from 0 to 10 points. In a retrospective study testing the efficacy of this classification we found that patients with an activity score of 3 or more at the beginning of therapy responded well to anti-inflammatory drugs, while those with a lower activity score mostly did not. Comparing the pretreatment activity score with the degree of enlargement of the extraocular muscles on the CT scan, we found a significant correlation between these two parameters: the higher the activity score, the more the enlargement of the muscles. We conclude that this classification facilitates the proper selection of patients for treatment. [ABSTRACT FROM PUBLISHER]

The purpose of this retrospective study is to investigate the influence of 45 Gy megavoltage external beam radiotherapy on the occurrence of second primary tumours in hereditary- and non-hereditary retinoblastoma patients. Eighty-seven hereditary and 19 nonhereditary patients were irradiated for retinoblastoma. The follow-up of the hereditary patients ranged from 4–23 years (mean 12.4 years), of the non-hereditary patients from 6–23 years (mean 12 years). In the hereditary group 4 patients developed a second primary tumour (2 rhabdomyosarcoma, 1 osteosarcoma, 1 malignant histiocytoma), and 5 patients developed a pineoblastoma. Three second primary tumours were situated inside the radiation field. The latency period ranged from 1.5 to 18 years (mean 4.8 years). None of the non-hereditary patients developed a second primary tumour. The actuarially calculated probability of being free from second primary tumours was 96.9% at 10 years and 89.4% at 20 years (pineoblastoma excluded). The survival was 91.2% at 10 years and 84.2% at 20 years (pineoblastoma excluded). From this study it is suggested that external beam irradiation has a potentiating effect in patients, with the genetic predispopsition for retinoblastoma and who are more susceptible to second primary malignancies. [ABSTRACT FROM AUTHOR]

A neonate presented with a dilated pupil of the left eye. Magnetic Resonance Imaging (MRI) showed a mass in the left inferior part of the orbit. Incisional biopsy was performed. Histopathological examination revealed ectopic brain tissue. The patient had a 5-year follow-up without any growth on MRI. Ectopic brain tissue in the orbit is a rare finding in the literature, almost all involved infants or neonates. Pathogenesis is still unknown. [ABSTRACT FROM AUTHOR]

Presents a case in a young teenager whose presentation mimicked that of an inflammatory or infectious dacryoadenitis rather than a neoplastic process in Great Britain. Epidemiology of pleomorphic adenoma; Clinical signs and symptoms; Diagnostic procedure recommended; Differential diagnosis.

Eye (2003) 17, 528-530. doi:10.1038/sj.eye.6700384 [ABSTRACT FROM AUTHOR]

We analysed the results of extraocular muscle surgery in 38 patients with stable Graves' ophthalmopathy. Fixed sutures were used in all patients. A useful field of binocular single vision was achieved in 27 patients (71%) after one operation and in seven patients (18%) after more than one, whereas double vision was persistent in four (11%). No recurrence of diplopia was seen during one year of follow-up. No differences were found in duration of eye disease, angle of deviation, or in prior forms of treatment between patients who responded well to a single operation and those who needed more surgical procedures or those who responded less well. We conclude that, although the individual outcome cannot be predicted, every patient with diplopia and stable Graves' ophthalmopathy has an 89% chance of binocular single vision after extraocular muscle surgery. Prior treatment does not appear to influence this outcome. [ABSTRACT FROM PUBLISHER]

This article reports an unusual case of epiphora caused by mechanical obstruction of the puncta by isolated neurofibromas. A 45-year-old lady, originally from Surinam, presented with a three year history of epiphora and irritation of both eyes. Visual acuity was normal. External examination revealed 'hypertrophy' of the upper and lower puncta of both eyes. Histology revealed that the lesions were neurofibromas. There were no other ocular features of neurofibromatosis. A thorough systemic examination including a neurology review with MRI revealed no other stigmata of neurofibromatosis and there was no family history of neurofibromatosis. Neurofibromas are benign peripheral nerve sheath tumours characterized by a combined proliferation of Schwann cells, endoneural fibroblasts, and axons. Three features of this case are unusual. Firstly, isolated conjunctival neurofibromas are rare and have not been previously described at the puncta causing epiphora. Secondly, neurofibromas are usually associated with systemic neurofibromatosis. A thorough systemic examination in this patient showed no signs of neurofibromatosis. Thirdly, patients with these lesions often present at an earlier age than our patient in the second or third decade of life.

A letter to the editor is presented in response to the article "Surveillance of Women at High Risk for Hereditary Ovarian Cancer is Inefficient," by A. L. Oei and others in the 2006 issue.