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Purpose: Investigate pain, fatigue, depressive symptoms and sleep disturbance in young adults with cerebral palsy compared to references. Materials and methods: Young adults with cerebral palsy (n = 97, aged 21–34 years) and age-matched references from the general population (n = 190) rated pain using a numeric rating scale and fatigue, depressive symptoms, sleep disturbance and global health using Patient-Reported Outcomes Measurement Information System® short forms. Scores were compared between cerebral palsy subgroups and the reference population. Correlation coefficients and linear regression analyses assessed interrelationships of health issues and associations with global health. Results: Individuals with Gross Motor Function Classification System level I had less pain, fatigue and depressive symptoms, while individuals with levels II and III–V had more pain (53% and 56%, p < 0.001) and those with levels III–V more fatigue (39%, p = 0.035) than references (pain: 26%, fatigue: 14%). Pain and fatigue were more interrelated (correlation coefficients: 0.71 vs. 0.41) and stronger associated with global mental health in individuals with cerebral palsy. Conclusions: Young adults with Gross Motor Function Classification System levels II–V report more pain and those with levels III–V report more fatigue than references. Pain and fatigue are highly interrelated and specifically relate to mental health in individuals with cerebral palsy.Implications for rehabilitation Except for those in the highest level of motor function, young adults with cerebral palsy report higher levels of pain and fatigue compared to the general population of the same age. Pain and fatigue are strongly interrelated and associated with mental health in young adults with cerebral palsy. The present study recommends to monitor pain and fatigue in young adults with cerebral palsy with low levels of gross motor function. We advise rehabilitation professionals to consider combined treatment for both pain and fatigue.

Aim To determine development curves of communication and social interaction from childhood into adulthood for individuals with cerebral palsy (CP). Method This Pediatric Rehabilitation Research in the Netherlands (PERRIN)‐DECADE study longitudinally assessed 421 individuals with CP, aged from 1 to 20 years at baseline, after 13 years (n=121 at follow‐up). Communication and social interactions were assessed using the Vineland Adaptive Behavior Scales. We estimated the average maximum performance limit (level) and age at which 90% of the limit was reached (age90) using nonlinear mixed‐effects modeling. Results One‐hundred individuals without intellectual disability were aged 21 to 34 years at follow‐up (39 females, 61 males) (mean age [SD] 28y 5mo [3y 11mo]). Limits of individuals without intellectual disability, regardless of Gross Motor Function Classification System (GMFCS) level, approached the maximum score and were significantly higher than those of individuals with intellectual disability. Ages90 ranged between 3 and 4 years for receptive communication, 6 and 7 years for expressive communication and interrelationships, 12 and 16 years for written communication, 13 and 16 years for play and leisure, and 14 and 16 years for coping. Twenty‐one individuals with intellectual disability were between 21 and 27 years at follow‐up (8 females, 13 males) (mean age [SD] 24y 7mo [1y 8mo]). Individuals with intellectual disability in GMFCS level V showed the least favourable development, but variation between individuals with intellectual disability was large. Interpretation Individuals with CP and without intellectual disability show developmental curves of communication and social interactions similar to typically developing individuals, regardless of their level of motor function. Those with intellectual disability reach lower performance levels and vary largely in individual development. What this paper adds Communication and social interactions in individuals with cerebral palsy without intellectual disability develop similarly to typically developing individuals.Communication and social interactions of individuals with intellectual disability develop less favourably and show large variation., What this paper adds Communication and social interactions in individuals with cerebral palsy without intellectual disability develop similarly to typically developing individuals.Communication and social interactions of individuals with intellectual disability develop less favourably and show large variation. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the http://onlinelibrary.wiley.com/doi/10.1111/dmcn.14351/abstract to view the translations.

To determine the long-term development of autonomy in participation of individuals with cerebral palsy (CP) without intellectual disability.Individuals with CP (n=189, 117 males, 72 females; mean age [SD] 21y 11mo [4y 11mo], range 12-34y); were assessed cross-sectionally (46%) or up to four times (54%), between the ages of 12 and 34 years. Autonomy in participation was classified using phase 3 of the Rotterdam Transition Profile. A logistic generalized estimating equation regression model was used to analyse autonomy in six domains (independent variables: age, Gross Motor Function Classification System [GMFCS] level, and interaction between age and GMFCS level). Proportions of autonomy were compared to references using binomial tests (p0.05).In most domains, over 90% of participants (n=189, 400 observations, 80% in GMFCS levels I and II) reached autonomy in participation in their late twenties, except for intimate/sexual relationships. Those in GMFCS levels III to V compared to those in GMFCS levels I and II had less favourable development of autonomy in the transportation, intimate relationships, employment, and housing domains, and more favourable development in the finances domain. Compared to references, fewer individuals with CP were autonomous in participation.This knowledge of autonomy may guide the expectations of young people with CP and their caregivers. Furthermore, rehabilitation professionals should address autonomy development in intimate relationships, employment, and housing, especially in individuals with lower gross motor function.Individuals with cerebral palsy without intellectual disability achieved autonomy in most participation domains. Regarding intimate relationships, they continued to have less experience compared to age-matched references. Development of autonomy was less favourable for individuals in Gross Motor Function Classification System levels III to V.AUTONOMÍA EN LA PARTICIPACIÓN EN LA PARÁLISIS CEREBRAL DESDE LA INFANCIA A LA EDAD ADULTA: OBJETIVO: Determinar el desarrollo a largo plazo de la autonomía en la participación de individuos con parálisis cerebral (PC) sin discapacidad intelectual. MÉTODO: Individuos con PC (n=189, 117 varones, 72 mujeres; edad media [DE] 21 años y 11 meses [4 años y 11meses], rango 12-34 años); fueron evaluados de forma transversal (46%) o hasta cuatro veces (54%), entre las edades comprendidas entre los 12 y los 34 años. La autonomía en la participación fue clasificada usando la fase 3 del perfil de transición de Rotterdam (Rotterdam Transition Profile). Se utilizó un modelo de regresión logístico generalizado estimando la ecuación para analizar la autonomía en 6 dominios (variables independientes: edad, nivel del Sistema de Clasificación de la Función Motora Gruesa, [GMFCS], y la interacción entre la edad y el nivel GMFCS). Las proporciones de la autonomía se compararon con las referencias mediante pruebas binomiales (p0,05). RESULTADOS: En la mayoría de los dominios, más del 90% de los participantes (n=189.400 observaciones, 80% en los niveles I y II de la GMFCS) alcanzaron la autonomía en la participación bien entrados los 20 años, excepto para las relaciones íntimas/sexuales. Aquellos en los niveles III y V de la GMFCS en comparación con los niveles I y II de la GMFCS tuvieron un desarrollo de la autonomía menos favorable en el transporte, relaciones íntimas, empleo y en el dominio de la vivienda, y un desarrollo más favorable en el dominio de las finanzas. En comparación con las referencias, menos individuos con PC fueron autónomos en la participación. INTERPRETACIÓN: Este conocimiento de la autonomía puede guiar las expectativas de los jóvenes con PC y de sus cuidadores. Además, los profesionales de la rehabilitación deberían abordar el desarrollo de la autonomía en las relaciones íntimas, el empleo y la vivienda, especialmente en aquellos individuos con una función motora gruesa más baja.AUTONOMIA NA PARTICIPAÇÃO EM PARALISIA CEREBRAL DA INFÂNCIA À VIDA ADULTA: OBJETIVO: Determinar o desenvolvimento em longo prazo da autonomia na participação de indivíduos com paralisia cerebral (PC) sem deficiência intelectual. MÉTODO: Indivíduos com PC (n=189, 117 do sexo masculino, 72 do sexo feminino; média de idade [DP] 21a 11m [4a 11m], variação 12-34a); foram avaliados transversalmente (46%) ou até quatro vezes (54%), entre as idades de 12 e 34 anos. A autonomia na participação foi classificada usando a fase 3 do Perfil de Transição de Rotterdam. Um modelo de regressão logística com generalizada com equações estimadas foi usado para analisar a autonomia em seis domínios (variáveis independentes: idade, Nível segundo o Sistema de Classificação da Função Motora Grossa [GMFCS], e interação entre idade e nível GMFCS). As proporções de autonomia foram comparadas com as referências usando testes binomiais (p0,05). RESULTADOS: Na maior parte dos domínios, cerca de 90% dos participantes (n=189.400 observações, 80% nos níveis GMFCS I e II) atingiram autonomia na participação no final da terceira década de vida, exceto para relações íntimas/sexuais. Aqueles nos níveis GMFCS III a V comparados com os níveis I e II tiveram desenvolvimento menos favorável nos domínios da autonomia no transporte, relações íntimas, emprego, e domicílio, e mais desenvolvimento mais favorável no domínio das finanças. Em comparação com as referências, menos indivíduos com PC foram autônomos na participação. INTERPRETAÇÃO: Este conhecimento sobre a autonomia pode guiar as expectativas de jovens com PC e seus cuidadores. Além disso, profissionais da reabilitação devem abordar o desenvolvimento da autonomia nas relações íntimas, emprego e domicílio, especialmente nos indivíduos com menor função motora grossa.

Aim This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy (CP) aged 1 to 24 years. Method As part of the Pediatric Rehabilitation Research in the Netherlands (PERRIN+), 424 individuals with CP (261 males, 163 females; mean age [SD] 9y 6mo [6y 2mo]; Gross Motor Function Classification [GMFCS] levels I–V [50% level I]; 87% with spastic CP; 26% with intellectual disability) were longitudinally followed for up to 4 years between 2002 and 2007. Social participation was assessed with the Vineland Adaptive Behavior Scales survey. Effects of age, GMFCS level and intellectual disability were analysed using multilevel modelling. Results The developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability. Interpretation Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age.

Resistance of bacteria to antibiotics in animal husbandry is increasing and a point of growing concern. The large use of antibiotics in agriculture undoubtedly leads to the development of antibiotic resistance. This has resulted in a growing public concern on the rise of antibiotic resistance, and in particular on the transmission of resistant bacteria and resistance markers from animals to humans. Large antibiotic use in animal husbandry and antibiotic resistance threatens the health and well being of man and animal through a diminished effectiveness of antibiotic treatments. It causes high costs of – unnecessary or ineffective – antibiotic treatments of animals, and it impairs the image and legitimacy of the intensive livestock sector resulting in a further decline of its societal support and the consumer’s demand for its products. Therefore, politicians and industry will have to make forward looking choices. In this White Paper we present work packages for research lines aimed at eliminating the systematic use of antibiotics in the animal production sector and therewith the emergence of, and selection for, antibiotic resistance. We consider it urgent that the animal husbandry will start producing antibiotic-free wherever and as much as possible. Such a development requires large changes in day-to-day practices, attitudes, and behaviour of all participating stakeholders in animal husbandry. Changes may be enabled by new technical solutions and a design of animal husbandry aimed at optimal disease prevention. It is an illusion that a simple solution will suffice to reduce antibiotic use in animal husbandry. Integrated, multidisciplinary and comprehensive approaches will be absolutely required to make progress. A “search-anddestroy” policy may further be necessary to combat remaining resistant bacteria after the use of antibacterials as selective force has been diminished. Het groeiende antibioticagebruik in de intensieve veehouderij leidt tot een toename van antibioticaresistente kiemen zoals MRSA. Het vormt daarmee een serieuze bedreiging voor de gezondheid van mens en dier. Om dit probleem aan te pakken zullen strategische keuzes gemaakt moeten worden door politiek en bedrijfsleven. De partners van de Kennisketen Infectieziekten Dier (KID) hebben een White Paper opgesteld met daarin een aantal voorstellen voor nader onderzoek om vragen, die bij het maken van die keuzes aan de orde komen, te kunnen beantwoorden. Het White Paper geeft een overzicht van kennis die ontbreekt en draagt voorstellen aan om deze kennis te vergaren, over te dragen en toe te passen.

A double blind randomized clinical trial was performed with pigs suffering from clinical respiratory disease. The goal of the trial was to test the null hypothesis that the clinical recovery after treatment with two oxytetracycline injectables with different pharmacokinetic profiles (high peak concentration and low persistence versus low peak concentrations and long persistence) was similar. Fattening pigs (n = 529) were treated intramuscularly with either product A or product B at a dose of 20 mg OTC per kg b.w. when they showed signs of acute pneumonia, i.e., coughing, tachypnoea or dyspnoea combined with a rectal temperature of 40 degrees C or higher. When necessary, treatment was given again after 3 and/or 6 days. Both treatments resulted in a rapid fall in mean temperature and an improved clinical condition. In this trial no significant differences were found in clinical recovery between the two therapies as measured by group mean temperature, number of pigs requiring retreatment, and time to recovery. The conclusion that there was no important difference in clinical recovery between the treatment groups was made with a power of at least 90%.

DETECTION AND TRANSMISSION OF EXTRACELLULAR FACTOR PRODUCING STREPTOCOCCUS SUIS SEROTYPE 2 STRAINS IN PIGS INTRODUCTION Streptococcus suis (S.suis) has been implicated in the etiology of many diseases among which meningitis in pigs. The virulent extracellular factor-positive strains of S.suis serotype 2 (S.suis2EF+) have frequently been isolated from diseased. Sows carrying S.suis strains in their tonsils are considered the most important source of infection for their susceptible offspring. DETECTION OF STREPTOCOCCUS SUIS To be able to perform transmission studies, a well-defined diagnostic method was needed. We estimated the sensitivity and specificity of a polymerase chain reac-tion assay (PCR) on swabs taken from live sows. The estimated sensitivity of PCR on swabs was 0.63 (). The PCR on the whole tonsil removed after euthanasia had a higher sensitivity of 0.88 (). The specificities of both tests were around 0.96. The sensitivity of swabs can be further increased by using a slightly more invasive technique like tooth-brushes. To perform test-characterization without a golden standard, Bayesian statis-tical analysis has been increasingly used. One of the assumptions when performing a Bayesian analysis is that the tests must be conditionally independent given the dis-ease status. In our model there was only an indication for moderate conditional de-pendence particularly between Tonsil-PCR and Tonsil-BE for true positives (6.8 %). Theoretically, dependency between tests can always be parameterized, but this will lead to wider credibility intervals and thus reduce the advantages of Bayesian analy-sis. PREVENTION AND CONTROL We investigated whether S.suis2EF+ can translocate from the intestinal tract to the internal organs of pigs. Weaned pigs were transported in a truck to induce stress. Half of them were inoculated with a high amount of S.suis2EF+ through a canula placed in the proximal jejunum to exclude the tonsil as infection route. After eutha-nasia, in three animals S.suis2EF+ was re-isolated from organs in contrast to control animals, indicating intestinal bacterial translocation. To prevent S.suis intestinal translocation at farms with severe streptococcus related disease problems after weaning, management must emphasize on improving the process of weaning, such as early habituation to solid food uptake and minimizing of moving and mixing of piglets. We examined the effect of a combination of a killed S.suis 2 EF+ whole-cell vaccine combined with amoxicillin on the S.suis2EF+ carrier status of sows and their offspring housed in individual farrowing rooms. Four weeks postpartum S.suis2EF+ could not be detected in the tonsils of the seven treated sows, but the tonsils of all seven untreated sows remained positive. However, only one of the litters of these untreated sows became infected. This showed that the incidence of vertical transmis-sion in farrowing pens is low. None of the litters of the treated sows became in-fected. CONCLUDING Farming systems with lower stock densities, less mixing and strictly spatial separation of age groups can reduce the risk of outbreaks of meningitis caused by S.suis. Vaccination strategies can support the prevention of disease outbreaks. Nevertheless, incidental cases of meningitis will remain because of the persistence of carriers of pathogenic S.suis strains.

Conventional weaning of piglets at the young age of 3 to 4 wk is associated with reduced nutrient intake, reduced growth, altered behavioral patterns, and a greater susceptibility to diarrhoea. It is known that an older age at weaning is associated with an improved adaptation to postweaning challenges, e.g. changes in housing and diet. However, extending lactation length is economically undesirable, since this will postpone the establishment of a next pregnancy of the sow. Inducing oestrus and ovulation in sows by Intermittent Suckling (IS; piglets are temporarily separated from their sow for several hours on each day from a certain age until weaning) might be a possible way to retain the reproductive activity of sows during an extended lactation period and to improve postweaning adaptation of piglets. The general aim of the current thesis was to determine whether IS during an extended lactation improves the adaptation of piglets to weaning. More specific, we investigated how IS regimens, differing in separation interval, timing and duration, affected 1) piglet pre- and postweaning growth and feed intake, 2) piglet behavior during the suckling period, 3) postweaning gut characteristics. Parameters currently used to investigate postweaning gut characteristics in piglets are end-point measurements, but 4) we aimed to monitor postweaning intestinal function of piglets longitudinally. With regard to separation interval, distributing the daily 12-h separation period over two 6-h separation intervals did not yield a profit with respect to piglet growth or feed intake. Onset of IS at an older age (3 wk instead of 2 wk) markedly improved feed intake stimulation, and shortened the period of postweaning growth reduction when piglets were already weaned after 1 wk of IS. Although 1 wk of IS before weaning (4 wk) improved postweaning feed intake and growth and prevented the postweaning villous atrophy compared to conventionally weaned piglets, it did not prevent a profound growth check shortly after weaning. However, combining 1 wk of IS with an extended lactation (weaning at 5 wk) improved postweaning adaptation markedly in terms of growth and feed intake. Increasing the duration of IS during this extended lactation from 1 to 2 wk further improved, although slightly, growth and feed intake shortly after weaning. Besides IS regimens, we investigated whether plasma citrulline and intestinal fatty acid binding protein (I-FABP) concentrations could be longitudinal markers for small intestinal function in piglets after weaning. Although plasma I-FABP concentrations were unaffected by weaning, the marked postweaning decline and correlation with intestinal absorption posed the plasma citrulline concentration as a possible marker. However, since in a later study no correlations were found with small intestinal morphology, its use needs to be evaluated in future research. In conclusion, IS is a promising management strategy to improve the adaptation of piglets to weaning, by preventing postweaning detrimental effects on piglet nutrient intake, growth, and small intestinal morphology. These effects are most profound when IS is combined with an extended lactation. In addition, IS was not associated with the development of behavioral patterns indicative for piglet distress.

Influenza virus infections in swine were first noticed in the US in 1918, during the human pandemic of the Spanish flu. In Europe, seroprevalences for the three most common swine influenza strains at the moment, H1N1, H3N2 and H1N2, range from 20-80% in finishing pigs at the end of the finishing period and in sows. However, little is known about the population dynamics of influenza virus within herds, or between herds. By investigating 53 outbreaks of acute respiratory disease over a period of four years, it was established that influenza virus infections are responsible for more than 50% of the acute respiratory disease outbreaks in swine. Virus circulation in weaned piglets was found to be very common, suggesting that weaned piglets may act as a reservoir for influenza virus in a herd. Virus infections at that time interfere with the presence of maternal antibodies, resulting in no noticeable clinical symptoms, but also in a lesser immunity than infections in fully susceptible pigs. The occurrence of influenza virus infections in finishing pigs was quite different in farrow-to finish herds when compared to finishing herds. For all subtypes, influenza virus infections in farrow-to-finish herds occurred mainly at a young age, up to and including the first half of the finishing period. In finishing herds on the other hand, the influenza virus infections mainly occurred in the second half of the finishing period. These differences may have implications for the choice of intervention measures, whether this is intervention through vaccination, or intervention through zoosanitary measures. Vaccines, while potentially highly efficacious, have the disadvantage that they are very specific for one infectious agent, or even one subtype of an infectious agent. The big advantage of zoosanitary measures compared to vaccination is that multiple infectious agents can be addressed at the same time with the same or similar measures. Measures with respect to air filtration and increased hygiene were therefore evaluated. These measures significantly reduced the number of influenza virus infections during the finishing period and therefore most likely also the magnitude of acute respiratory disease. These measures are unlikely to be cost-beneficial when they are only applied for influenza virus infections, but the application of such measures in a broader context may offer some prospects

In Europe, piglets are usually weaned before 4 weeks of age, thus changing abruptly from highly digestible milk to a less digestible starter diet, resulting in reduced feed intake and growth after weaning and sometimes post weaning diarrhea. Intake of a sufficient amount of creep feed during lactation can reduce these post weaning problems, but creep feed consumption is usually low and highly variable. This thesis describes the effect of intermittent suckling (IS; a management technique in which piglets are separated from the sow for 12 h/ day from d 14 to weaning (d 25), on performance of pigs before and after weaning. IS increased average creep feed intake during lactation. Distribution of creep feed intake shifted from a skewed one, with a majority of litters consuming less than 250 g.piglet-1 in control litters, to a normal distribution with an average creep feed intake of 500 to 750 g.piglet-1 in IS litters. The higher creep feed intake caused by IS resulted in better performance after weaning: IS litters had higher feed intake and higher weight gain in the first two weeks after weaning. Thereafter no differences were found until slaughter. IS litters with little or no creep feed intake during lactation tended to have higher weight gains and feed intake after weaning than control litters with comparable creep feed intake during lactation. IS did not increase the percentage of eaters within a litter during lactation and weaning weights did not differ between eaters and non-eaters. From one until four weeks after weaning piglets that were eaters during lactation had higher weights than non-eaters. IS did not affect feeder visiting behaviour of piglets from litters with an anyhow high level of feed intake during lactation, but IS piglets from litters with a low level of feed intake were stimulated to visit the feeder during lactation, which probably made them already familiar with the feeder and the feed. Part of the variation in feed intake between litters might be explained by differences in suckling behaviour and activity. To investigate if IS and/or creep feed intake affects the absorptive capacity of the small intestines, an in vivo small intestine segment perfusion test was performed in 24 newly weaned piglets (6 eaters and 6 non- eaters from each treatment). Net absorption in non-infected segments of the small intestine was significantly higher in eaters than in non-eaters. No difference was found between IS and control piglets. IS also affected the sows: weight loss during lactation was decreased and ovulations were advanced. The results of these studies demonstrate that IS improves both creep feed intake during lactation and feed intake and weight gain after weaning. Piglets consuming creep feed during lactation had higher weights and net absorption in the small intestine after weaning, independent of the suckling regimen. IS was especially efficient in piglets from low feed intake litters; these piglets were stimulated to investigate the feeder during lactation, which facilitated consumption of feed after weaning.