Search

Paratuberculosis (Johne's disease) is a chronic infectious disease of ruminants, caused by Mycobacterium avium subspecies paratuberculosis (MAP). Because of its long incubation period, high economic losses, difficulties in diagnosis and possible links to Morbus Crohn in humans, paratuberculosis is one of the most important diseases of ruminants today. An abattoir-based nationwide survey on the occurrence of MAP in the Austrian cattle population was performed using serology (SVANOVIR-ELISA) as well as culture, ZN-stain and IS900-PCR on faeces and lymph node samples. A total of 756 Austrian slaughter cattle were serologically, bacteriologically and molecularbiologically tested for the occurrence of MAP and specific antibodies respectively. Samples were collected following a statistical plan to obtain balanced specimens from the whole country. Nineteen per cent of the animals tested were serological positive, 10.1% gave an inconclusive result and 70.9% showed no specific antibodies against MAP. Only in four individuals MAP could be detected by stain, bacteriology or Polymerase Chain Reaction. The calculated prevalence of 19.0% positive cattle, each representing one farm, showing specific antibodies against MAP is rather high in terms of animal-level but low in herd level prevalence compared with other countries. When this study is compared with a similar study performed in Austria 1999, a significant increase of positive cattle and farms could be seen in Austria.

Besides the integrated psychosomatic models in various medical specialities (e.g. Internal medicine, Obstetrics and Gynaecology or Paediatrics), specific models of cooperation in the form of consultation-liaison (C-L) service between specialised psychosomatic-psychotherapeutic departments and other medical departments play a crucial role in providing psychosomatic care to patients. The concept 'liaison' expresses a particularly close form of cooperative activity, going far beyond the classical model of consultation services. In this context, the psychosomatic consultant has not only a fixed organised presence in the provision of patient care, he/she also participates in case discussions, hospital rounds, ward discussions and continuing education programmes of the 'partner' department. Thus, the liaison service is not only patient-centred, but also team-centred. Such consultation-liaison services, in Austria, were first established at the University Hospitals. As a consequence of laws regulating psychotherapeutic care, according to which such care is to be offered in general hospitals, increasingly C-L services are becoming part of regular care provision in more and more hospitals. Consensus groups, international as well as in German-speaking countries, are currently working on establishing quality standards in the area of psychosomatic C-L services. A working group of the scientific medical representatives has recently published guidelines for the structure, process and results of quality control. A second group, of the European Association of Consultation Liaison Psychiatry and Psychosomatics, is currently working on guidelines for training consultation-liaison service providers. In the present article, an overview of these projects will be presented and the results discussed against the background of the specific health policy situation in Austria.