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The presence and importance of visual oestrous symptoms and the relation to conception, breed, housing system and milk yield were studied. Data were collected from a Swedish research herd during a 16-year period. Local, secondary and primary oestrous symptoms and an overall oestrus intensity score (OI) were studied. Decreasing trends in oestrous expression and conception rates (CR), and an increase in CR with more intensive oestrus, from 24% at OI score one (very week) to 54% at OI score five (very strong) were observed. The mean interval from first to last observed oestrus symptom was long with a large variation (54 ± SD = 32 h). Generally, irrespectively of housing system, Swedish Red cows had higher CR, more intensive oestruses and longer oestrus durations compared to Swedish Holstein cows. Local oestrous symptoms, with CR of 24–28%, were most frequently detected, which is why more attention should be paid to local oestrous symptoms. [ABSTRACT FROM PUBLISHER]

The main aim was to assess the impact of mastitis on technical and economic results of a dairy herd under current Swedish farming conditions. The second aim was to investigate the effects obtained by withdrawing milk with high somatic cell count (SCC). A dynamic and stochastic simulation model, SimHerd, was used to study the effects of mastitis in a herd with 150 cows. Results given the initial incidence of mastitis (32 and 33 clinical and subclinical cases per 100 cow-years, respectively) were studied, together with the consequences of reducing or increasing the incidence of mastitis by 50%, modelling no clinical mastitis (CM) while keeping the incidence of subclinical mastitis (SCM) constant and vice versa. Six different strategies to withdraw milk with high SCC were compared. The decision to withdraw milk was based on herd-level information in three scenarios: withdrawal was initiated when the predicted bulk tank SCC exceeded 220 000, 200 000 or 180 000 cells/ml, and on cow-level information in three scenarios: withdrawal was initiated when the predicted SCC in an individual cow's milk exceeded 1 000 000, 750 000 or 500 000 cells/ml. The accuracy with which SCC was measured and predicted was assumed to affect the profitability of withdrawing milk with high SCC and this was investigated by applying high, low or no uncertainty to true SCC. The yearly avoidable cost of mastitis was estimated at h8235, assuming that the initial incidence of mastitis could be reduced by 50%. This cost corresponded to 5% of the herd net return given the initial incidence of mastitis. Expressed per cow-year, the avoidable cost of mastitis was h55. The costs per case of CM and SCM were estimated at €278 and €60, respectively. Withdrawing milk with high SCC was never profitable because this generated a substantial amount of milk withdrawal that was not offset by a sufficient increase in the average price per delivered kg milk. It had the most negative impact on net return when high incidence of mastitis was simulated. Withdrawing milk with high SCC based on low-uncertainty information reduced the amount of withdrawn milk and thus resulted in less negative effect on net return. It was concluded that the current milk-pricing system makes it more profitable for farmers to sell a larger amount of milk with higher SCC than to withdraw milk with high SCC to obtain payment premiums, at least in herds with mastitis incidences within the simulated ranges. [ABSTRACT FROM AUTHOR]

Most dairy cows used in organic dairy production today are of high producing breeds, bred within the conventional production system. The aim of this study was to investigate the occurrence of genotype by environment (G×E) interactions between organic and conventional dairy production in Sweden, to see if they are of a magnitude justifying development of a separate breeding program for organic production. Records of production, fertility, and somatic cell count in Swedish Holstein and Swedish Red cows in first and second lactation, collected between 1998 and 2005 in 424 organic and 5564 conventional herds, were analyzed. Indications of G×E were only found for three fertility traits; calving interval, the interval from calving to last insemination, and pregnant at first insemination, in second lactation Swedish Holstein. This, together with the small organic population, does not justify development of a separate breeding program for cows in organic production in Sweden. [ABSTRACT FROM AUTHOR]

The influence of previous antibiotic therapy on the aerobic faecal flora, including P-fimbriated Escherichia coli, was studied in 953 neonates at discharge from 22 neonatal wards in Sweden. Antibiotics, mainly ampicillin (with or without gentamicin) or cefuroxime, had been received by 37% of the infants. Treatment with ampicillin (with or without gentamicin) increased Klebsiella/Enterobacter and reduced Esch. coli colonization. Cephalosporin therapy (71% cefuroxime) reduced the frequency of colonization with both Esch. coli and Klebsiella/Enterobacter spp. but doubled the isolation rate of other Gram-negative bacteria (Citrobacter, Pseudomonas, Proteus and Acinetobacter spp.) and tripled the incidence of specimens yielding no aerobic Gram-negative growth. Gentamicin showed no significant ecological impact. The selection of Klebsiella/Enterobacter and P-negative Esch. coli strains by ampicillin was correlated with their resistance to this agent, while the association between P-fimbriated Esch. coli and cefuroxime therapy was not related to cefuroxime resistance. [ABSTRACT FROM AUTHOR]

Contents The effects of increased calving intervals on reproduction were studied in two herds. In Herd 1 cows were managed for 12- or 15-month calving intervals and in Herd 2 for 12- or 18-month intervals. Data from the study revealed that managing cows for a longer calving interval improved the fertility. Animals with a short interval needed more hormonal treatments to be inseminated on time due to anoestrus, compared to animals with longer intervals. Once the animals were inseminated there was a tendency for a higher conception rate at first AI in the 15-month group compared with the 12-month group. The cows in the 15-month group needed a lower number of AIs per serviced cow and a shorter period from the first AI to conception. Culling due to fertility problems was more frequent in the 12-month group. A longer period of days open did not imply an increased risk for development of cystic ovaries and did not result in weaker heat symptoms over time. [ABSTRACT FROM AUTHOR]

Abstract: We examined whether infrequent milk sampling for progesterone analysis could be used as a management or diagnostic tool by the dairy farmer to predict delayed ovarian cyclicity in dairy cows. The data included 1040 lactations from 324 Swedish Red cows and 183 Swedish Holstein cows and were randomly divided into two datasets. A logistic regression model was fit to the first dataset and the model was then validated on the other dataset. The model was also validated using a British dataset comprising 1212 lactations from 1080 British Holstein-Friesian cows. The dependent variable was whether delayed ovarian cyclicity occurred or not, delayed ovarian cyclicity defined as progesterone levels below threshold value for the first 56 or 45 days postpartum in the Swedish or British dataset, respectively. The basic model included the effects of breed, parity, season and housing type. To the basic model various progesterone-based measurements were added. These were the interval from calving to commencement of luteal activity and the percentage of samples with luteal activity within 60 days after calving, using all samples in the databases or one sample per month. The accuracy of the conditional probability of delayed ovarian cyclicity calculated with the different models was obtained using receiver operating characteristic (ROC) curves and calculating the area under curve. Sensitivity and specificity were calculated for cut-off probabilities using the ROC analyses. The accuracy was highest (0.94–0.99) when including the progesterone measurements based on milk sampling for progesterone analysis 2–3 times per week. The accuracy was between 0.85 and 0.88 when the progesterone measurements with monthly milk sampling were added to the model and 0.76 or 0.67 with the basic model. This study clearly shows that infrequent milk sampling for progesterone analysis, such as once a month as in the regular milk recording system, could be used to predict delayed ovarian cyclicity in dairy cows. This increases the opportunity for earlier treatment of anovulatory dairy cows and may therefore decrease involuntarily extended calving intervals in the herd. [Copyright &y& Elsevier]

Background: Reducing the time to treatment by means of cardiopulmonary resuscitation (CPR) and defibrillation is essential to increasing survival after cardiac arrest. A novel method of dispatching drones for delivery of automated external defibrillators (AEDs) to the site of a suspected out-of-hospital cardiac arrest (OHCA) has been shown to be feasible, with the potential to shorten response times compared with the emergency medical services. However, little is known of dispatchers' experiences of using this novel methodology., Methods: A qualitative semi-structured interview study with a phenomenological approach was used. Ten registered nurses employed at an emergency medical dispatch centre in Gothenburg, Sweden, were interviewed and the data was analysed by qualitative content analysis. The purpose was to explore dispatcher nurses' experiences of deliveries of AEDs by drones in cases of suspected OHCA., Results: Three categories were formed. Nurses expressed varying compliance to the telephone-assisted protocol for dispatch of AED-equipped drones. They experienced uncertainty as to how long would be an acceptable interruption from the CPR protocol in order to retrieve a drone-delivered AED. The majority experienced that collegial support was important. Technical support, routines and training need to be improved to further optimise action in cases of drone-delivered AEDs handled by dispatcher nurses., Conclusions: Although telephone-assisted routines for drone dispatch in cases of OHCA were available, their use was rare. Registered nurses showed variable degrees of understanding of how to comply with these protocols. Collegial and technical support was considered important, alongside routines and training, which need to be improved to further support bystander use of drone-delivered AEDs. As the possibilities of using drones to deliver AEDs in cases of OHCA are explored more extensively globally, there is a good possibility that this study could be of benefit to other nations implementing similar methods. We present concrete aspects that are important to take into consideration when implementing this kind of methodology at dispatch centres., (© 2024. The Author(s).)

The effect of carrier status of 10 lethal recessive genetic defects on pregnancy maintenance in Swedish dairy cattle was examined. The genetic defects were Ayrshire Haplotype 1, Ayrshire Haplotype 2, BTA12, BTA23, and Brown Swiss Haplotype 2 in Red Dairy Cattle (RDC), and Holstein Haplotype 1, 3, 4, 6, and 7 (HH1-HH7) in Holstein. Effects of carrier status of BTA12 and HH3 on conception rate (CR), interval from first to last service (FLS), and milk production were also examined. Data were obtained for 1,429 herds in the Swedish milk recording system, while information on carrier status of genetic defects was obtained from the Nordic Cattle Genetic Evaluation. In total, data on 158,795 inseminations in 28,432 RDC and 22,018 Holstein females were available. Data permitted separate analyses of BTA12 and HH3, but carrier frequencies of other defects were too low to enable further analysis. Pregnancy loss was defined as failure to maintain pregnancy, where pregnancy status was confirmed with manual and chemical pregnancy diagnosis, insemination, calving, sales and culling data. Odds ratios (OR) and probabilities of pregnancy loss and CR were estimated using generalized linear mixed models, while pregnancy loss, CR, FLS, milk, protein, and fat yields were analyzed using linear mixed models. Pregnancy losses were reported on average within the first month post-AI. At-risk matings were more prone to suffer pregnancy loss in BTA12 (OR = 1.79) and HH3 carriers (OR = 1.77) than not-at-risk matings. At-risk matings also had lower CR (OR = 0.62 and 0.63 for BTA12 and HH3, respectively) than not-at-risk matings. Carrier females of BTA12 had longer FLS and higher milk production than noncarriers. Conception rate and pregnancy maintenance could be improved by avoiding at-risk matings. This finding could help reduce pregnancy loss due to genetic defects in the breeding program for improved fertility., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Objective: To study clinical outcome and risk factors associated with extended-spectrum β-lactamase (ESBL)-producing uropathogenic Escherichia coli (UPEC) in community-onset bloodstream infections (CO-BSI)., Methods: This was a population-based cohort study including patients with pheno- and genotype-matched ESBL-producing E. coli and non-ESBL- E. coli in urine and blood samples collected in 2009-2018 in southeast Sweden. Seventy-seven episodes of ESBL-UPEC satisfying the inclusion criteria were matched 1:1 with 77 non-ESBL-UPEC for age, gender, and year of culture., Results: The most common ST-type and ESBL gene was ST131 (55%), and blaCTX-M-15 (47%), respectively. Risk factors for ESBL-UPEC were: previous genitourinary invasive procedure (RR 4.66; p = 0.005) or history of ESBL-producing E. coli (RR 12.14; p = 0.024). There was significant difference between ESBL-UPEC and non-ESBL-UPEC regarding time to microbiologically appropriate antibiotic therapy (27:15 h vs. 02:14 h; p = <0.001) and hospital days (9 vs. 5; p = <0.001), but no difference in 30-day mortality (3% vs. 3%; p = >0.999) or sepsis within 36 hours (51% vs. 62%; p = 0.623) was observed., Conclusion: The predominant risk factors for ESBL-UPEC were history of ESBL-Ec infection and history of genitourinary invasive procedure. The overall mortality was low and the delay in appropriate antibiotic therapy did not increase the risk for 30-day mortality or risk for sepsis within 36 hours among patients infected with ESBL UPEC. However, these results must be regarded with some degree of caution due to the small sample size., Competing Interests: The authors have declared that no competing interests exist.

High-yielding dairy cows are often fed high proportions of cereal grain and pulses. For several reasons, it would be desirable to replace these feed sources with forage, which is not suitable for human consumption. Feeding large amounts of forage to dairy cows could also make dairy production more publicly acceptable in the future. In this study, we estimated genetic parameters for total dry matter intake (DMI), DMI from forage (DMI For ), energy-corrected milk (ECM), and ECM produced from forage (ECM For ). A total of 1,177 lactations from 575 cows of Swedish Red (SR) and Holstein (HOL) dairy breeds were included in the study. Mixed linear animal random regression models were used, with fixed effect of calving season and lactation week nested within parity 1 and 2+, fixed effect of calving year, and random regression coefficients for breeding value (up to linear) and permanent environmental effect (up to quadratic) of the cow. Heritability for DMI and DMI For was generally higher for HOL than for SR in all-parity data and in later parities; however, the opposite was true for first parity. Heritability for DMI and DMI For during the first 8 wk averaged 0.11 and 0.15, respectively, in all-parity data for the 2 breeds. Corresponding values for ECM For and ECM were 0.21 and 0.29, respectively. In first parity, values were 0.32, 0.36, 0.28, and 0.51, respectively. The genetic correlation between DMI and DMI For was high, above 0.83, and fairly constant across the lactation. The genetic correlation between ECM For and ECM was close to unity in the later part of lactation for both breeds, but was around 0.8 in the early lactation for both breeds; it decreased for HOL to 0.54 in wk 17. The genetic correlations between DMI and ECM For and between DMI For and ECM For were low and negative for HOL (absolute value ∼0.2-0.3), but changed for SR from weakly positive in early lactation to negative values and back to positive toward the end of lactation. For most traits, the correlation between wk 1 and wk 8 into the lactation was very high; the lowest value was for DMI in HOL at 0.81. The genetic correlation between parities was rather high in the first part of the lactation. During the first 8 wk, the correlation was lower for HOL than for SR, except for ECM. We found that DMI For and ECM For showed reasonably large heritability, and future work should explore the possibility of genomic evaluations., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)

This study assessed the extent of reproductive losses and associated genetic parameters in dairy cattle, using in-line milk progesterone records for 14 Swedish herds collected by DeLaval's Herd Navigator. A total of 330,071 progesterone samples were linked to 10,219 inseminations (AI) from 5,238 lactations in 1,457 Swedish Red and 1,847 Swedish Holstein cows. Pregnancy loss traits were defined as early embryonic loss (1-24 d after AI), late embryonic loss (25-41 d after AI), fetal loss (42 d after AI until calving), and total pregnancy loss (from d 1 after AI until calving). The following classical fertility traits were also analyzed: interval from calving to first service, interval from calving to last service, interval between first and last service, calving interval, and number of inseminations per service period. Least squares means with standard error (LSM ± SE), heritabilities, and genetic correlations were estimated in a mixed linear model. Fixed effects included breed, parity (1, 2, ≥3), estrus cycle number when the AI took place, and a linear regression on 305-d milk yield. Herd by year and season of AI, cow, and permanent environmental effect were considered random effects. Extensive (approximately 45%) early embryonic loss was found, but with no difference between the breeds. Swedish Red was superior to Swedish Holstein in the remaining pregnancy loss traits with, respectively: late embryonic loss of 6.1 ± 1.2% compared with 13.3 ± 1.1%, fetal loss of 7.0 ± 1.2% compared with 12.3 ± 1.2%, and total pregnancy loss of 54.4 ± 1.4% compared with 60.6 ± 1.4%. Swedish Red also had shorter calving to first service and calving to last service than Swedish Holstein. Estimated heritability was 0.03, 0.06, and 0.02 for early embryonic, late embryonic, and total pregnancy loss, respectively. Milk yield was moderately genetically correlated with both early and late embryonic loss (0.52 and 0.39, respectively). The pregnancy loss traits were also correlated with several classical fertility traits (-0.46 to 0.92). In conclusion, Swedish Red cows had lower reproductive loss during late embryonic stage, fetal stage, and in total, and better fertility than Swedish Holstein cows. The heritability estimates for pregnancy loss traits were of the same order of magnitude as previously reported for classical fertility traits. These findings could be valuable in work to determine genetic variation in reproductive loss and its potential usefulness as an alternative fertility trait to be considered in genetic or genomic evaluations., (The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The second to fourth digit ratio (2D:4D ratio) is suggested to be a negative correlate of prenatal testosterone. Little is known about the role of the 2D:4D ratio in relation to serum and urinary androgens for physical performance in female athletes. We aimed to compare the 2D:4D ratio in female Olympic athletes with sedentary controls, and to investigate the 2D:4D ratio in relation to serum and urinary androgens and physical performance in the athletes. Methods: This cross-sectional study included 104 Swedish female Olympic athletes participating in power, endurance and technical sports and 117 sedentary controls. The 2D:4D ratio was calculated using direct digit measurements. Serum androgens and urinary androgen metabolites were analyzed by liquid chromatography-tandem mass spectrometry. The athletes performed standardized physical performance tests and body composition was established by dual-energy X-ray absorptiometry. Results: The 2D:4D ratio was significantly lower in the athletes compared with controls although serum testosterone levels were comparable between groups and within normal reference values. The 2D:4D ratio correlated negatively with urinary levels of testosterone glucuronide and 5α- and 5βAdiol-17G, whereas there were no correlations to serum androgen levels. Furthermore, the 2D:4D ratio correlated negatively with strength tests and positively with 3,000-meter running in the athletes. Conclusion: Female Olympic athletes had a lower 2D:4D ratio, possibly reflecting a higher prenatal androgen exposure, than sedentary controls. Furthermore, the 2D:4D ratio was related to urinary levels of androgen metabolites and physical performance in the athletes but not to serum androgen levels. It is suggested that the 2D:4D ratio could reflect androgen metabolism and may be of importance for sporting success in female athletes., (Copyright © 2020 Eklund, Ekström, Thörngren, Ericsson, Berglund and Hirschberg.)

Evaluating fertility traits based on endocrine progesterone profiles is becoming a promising option to improve dairy cow fertility. Several studies have been conducted on endocrine fertility traits, mainly in the Holstein breed. In this study, focusing also on the Swedish Red (SR) breed, genetic parameters were estimated for classical and endocrine fertility traits, the latter based on in-line milk progesterone records obtained for 14 Swedish herds using DeLaval Herd Navigator (DeLaval International, Tumba, Sweden). A total of 210,403 observations from 3,437 lactations of 1,107 SR and 1,538 Holstein cows were used. Mixed linear animal models were used for estimation of genetic parameters. Least squares means analysis showed that Holstein cows had a 2.5-d-shorter interval from calving to commencement of luteal activity (C-LA) and longer length of first inter-ovulatory interval (IOI) than SR cows. The highest mean interval for C-LA, IOI, and first luteal phase length (LPL) was observed in the fourth parity. The incidence of short (<18 d), normal, (18-24 d), and long (>24 d) IOI was 29.3, 40.7, and 30%, respectively. Genetic analysis indicated moderate heritability (h 2 ) for C-LA (h 2 = 0.24), luteal activity during the first 60 d in milk (LA60, h 2 = 0.15), proportion of samples with luteal activity (PLA, h 2 = 0.13), and calving to first heat (CFH, h 2 = 0.18), and low heritability estimates for LPL (h 2 = 0.08) and IOI (h 2 = 0.03) in the combined data set for both breeds. Similar heritability estimates were obtained for each breed separately except for IOI and LPL in SR cows, for which heritability was estimated to be zero. Swedish Red cows had 0.01 to 0.06 higher heritability estimates for C-LA, LA60, and PLA than did Holstein cows. Calving interval had moderate heritability among the classical traits for Holstein and the combined data set, but h 2 was zero for SR. Commencement of luteal activity had a strong genetic correlation with LA60 (mean ± SE; -0.88 ± 0.06), PLA (-0.72 ± 0.11), and CFH (0.90 ± 0.04). Similarly, CFH had a strong genetic correlation with IOI (0.98 ± 0.20). Number of inseminations per series showed a weak genetic correlation with all endocrine traits except IOI. Overall, endocrine traits had higher heritability estimates than classical traits in both breeds, and may have a better potential to explain the actual reproductive status of dairy cows than classical traits. This might favor inclusion of some endocrine fertility traits-especially those related to commencement of luteal activity-as selection criteria and breeding goal traits if recording becomes more common in herds. Further studies on genetic and genomic evaluations for endocrine fertility traits may help to provide firm conclusions. A prerequisite is that the data from automatic devices be made available to recording and breeding organizations in the future and included in a central database., (Copyright © 2019 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Background: Pregnancy loss is a major source of infertility in dairy cows. Despite a fertilization rate after insemination (AI) of approximately 90%, calving rates are 30%-50%, indicating the occurrence of extensive embryonic and foetal losses. The aim of this study was to establish the extent and pattern of embryonic and foetal loss in Swedish Red (SR) and Swedish Holstein (SH) dairy cows, as well as, the relationship to oestrus intensity (OI) and progesterone (P4) concentration. In total, 2130 AIs and 16,176 milk P4 samples from 359 SR and 212 SH dairy cows were included in the study. Pregnancy losses were estimated using data from P4 values combined with AI information and calving data., Results: Total pregnancy loss from AI to the day of calving was 65%. Early embryonic loss, late embryonic loss and foetal loss were estimated to be 29, 14 and 13%, respectively. There is strong evidence in the literature that P4 concentrations at different time points are associated with pregnancy loss. In the present study, cows with pregnancy losses had significantly higher P4 levels at the day of AI and significantly lower P4 concentration at days 10, 21 and 30 after AI compared to pregnant cows. Swedish Red cows had significantly lower total pregnancy losses compared to SH cows (62% and 68% respectively, P = 0.017). Early embryonic loss was 6.7% points lower for cows inseminated at a stronger OI (OI = 3) compared to at a weaker OI (OI = 2, P = 0.006). Cows inseminated at ovulation number ≥ 5 had significantly lower early pregnancy losses compared to cows inseminated at first or second ovulation (11.5 and 8% points, respectively, P < 0.05). With an increase of one SD of milk (448 kg ECM) during the first 60 days in milk, early embryonic loss increased by 4.7% points (P = 0.006)., Conclusions: It is important to increase the number of cows calving per insemination by reducing embryo/foetal loss. This outcome can be achieved by management and breeding for optimal P4 levels at critical time points, and by considering oestrus expression in the breeding programmes to facilitate the correct timing of insemination.

The main objective of this study was to investigate the benefit of accuracy of genomic prediction when combining records for an intermediate physiological phenotype in a training population with records for a traditional phenotype. Fertility was used as a case study, where commencement of luteal activity (C-LA) was the physiological phenotype, whereas the interval from calving to first service and calving interval were the traditional phenotypes. The potential accuracy of across-country genomic prediction and optimal recording strategies of C-LA were also investigated in terms of the number of farms and number of repeated records for C-LA. Predicted accuracy was obtained by estimating population parameters for the traits in a data set of 3,136 Holstein Friesian cows with 8,080 lactations and using a deterministic prediction equation. The effect of genetic correlation, heritability, and reliability of C-LA on the accuracy of genomic prediction were investigated. When the existing training population was 10,000 bulls with reliable estimated breeding value for the traditional trait, predicted accuracy for the physiological trait increased from 0.22 to 0.57 when 15,000 cows with C-LA records were added to the bull training population; but, when the interest was in predicting the traditional trait, we found no benefit from the additional recording. When the genetic correlation was higher between the physiological and traditional traits (0.7 instead of 0.3), accuracy increased less when adding the 15.000 cows with C-LA (from 0.51 to 0.63). In across-country predictions, we observed little to no increase in accuracy of the intermediate physiological phenotype when the training population from Sweden was large, but when accuracy increased the training population was small (200 cows), from 0.19 to 0.31 when 15,000 cows were added from the Netherlands (genetic correlation of 0.5 between countries), and from 0.19 to 0.48 for genetic correlation of 0.9. The predicted accuracy initially increased substantially when recording on the same farm was extended and multiple C-LA records per cow were used in prediction compared with single records; that is, accuracy increased from 0.33 with single records to 0.38 with multiple records (on average 1.6 records per cow) from 2 yr of recording C-LA. But, when the number C-LA per cow increased beyond 2 yr of recording, we noted no substantial benefit in accuracy from multiple records. For example, for 5 yr of recording (on average 2.5 records per cow), accuracy was 0.47; on doubling the recording period to 10 yr (on average 3.1 records per cow), accuracy increased by 0.07 units, whereas when C-LA was recorded for 15 yr (on average 3.3 records per cow) accuracy increased only by 0.05 units. Therefore, for genomic prediction using expensive equipment to record traits for training populations, it is important to optimize the recording strategy. The focus should be on recording more cows rather than continuous recording on the same cows., (Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Background: Many individuals with Ehlers-Danlos Syndrome (EDS) are hypermobile, suffer from long term pain, and have complex health problems. Since these sometimes have no objective physical signs, individuals with EDS sometimes are referred for psychiatric evaluation. The aim was therefore to identify the level of anxiety and quality of life in a Swedish group of individuals with EDS., Methods: A postal survey in 2008 was distributed to 365 members over 18 years of the Swedish National EDS Association and 250 with EDS diagnosis responded. Two questionnaires, the Hospital Anxiety and Depression Scale (HADS) and SF-36, were used. A Swedish population study was used to compare results from SF-36. Independent Student's t-test was used to compare differences between groups, possible relationships were tested using Spearman's correlation coefficient and the General Linear Model was used for regression analyses. Higher scores on HADS represent higher levels of anxiety and depression and higher scores on SF-36 represent higher quality of health., Results: Of the respondents 74.8% scored high on anxiety and 22.4% scored high on depression on the HADS. Age, tiredness and back pain was independently associated with the HAD anxiety score in a multiple regression analysis, When comparing the SF-36 scores from the EDS group and a Swedish population group, the EDS group scored significantly lower, indicating lower health-related quality of health than the general population (p < 0.001)., Conclusions: In comparison with a Swedish population group, a lower health-related quality of life was found in the EDS group. Also, higher levels of anxiety and depression were detected in individuals with EDS. The importance to explore the factors behind these results and what initiatives can be taken to alleviate the situation for this group is emphasized.

Elderly persons' perceived accessibility to railway traveling depends on their functional limitations/diseases, their functional abilities and their travel behaviors in interaction with the barriers encountered during whole trips. A survey was conducted on a random sample of 1000 city residents (65-85 years old; 57% response rate). The travels were perceived least accessible by respondents with severely reduced functional ability and by those with more than one functional limitation/disease (e.g., restricted mobility and chronic pain). Those who traveled "often", perceived the accessibility to be better than those who traveled less frequently. For travelers with high functional ability, the main barriers to more frequent traveling were travel costs and low punctuality. For those with low functional ability, one's own health was reported to be the main barrier. Our results clarify the links among existing functional limitations/functional abilities, the barriers encountered, the travel behavior, and the overall accessibility to traveling. By operationalizing the whole-trip concept as a chain of events, we deliver practical knowledge on vulnerable groups for decision-making to improve the transport environment for all.

Recently, there have been growing concerns about pharmaceuticals including antibiotics as environmental contaminants. Antibiotics of concentrations commonly encountered in wastewater have been suggested to affect bacterial population dynamics and to promote dissemination of antibiotic resistance. Conventional wastewater treatment processes do not always adequately remove pharmaceuticals causing environmental dissemination of low levels of these compounds. Using constructed wetlands as an additional treatment step after sewage treatment plants have been proposed as a cheap alternative to increase reduction of wastewater contaminants, however this means that the natural microbial community of the wetlands becomes exposed to elevated levels of antibiotics. In this study, experimental surface-flow wetlands in Sweden were continuously exposed to antibiotics of concentrations commonly encountered in wastewater. The aim was to assess the antibiotic removal efficiency of constructed wetlands and to evaluate the impact of low levels of antibiotics on bacterial diversity, resistance development and expression in the wetland bacterial community. Antibiotic concentrations were measured using liquid chromatography-mass spectrometry and the effect on the bacterial diversity was assessed with 16S rRNA-based denaturing gradient gel electrophoresis. Real-time PCR was used to detect and quantify antibiotic resistance genes and integrons in the wetlands, during and after the exposure period. The results indicated that the antibiotic removal efficiency of constructed wetlands was comparable to conventional wastewater treatment schemes. Furthermore, short-term treatment of the constructed wetlands with environmentally relevant concentrations (i.e. 100-2000 ng×l(-1)) of antibiotics did not significantly affect resistance gene concentrations, suggesting that surface-flow constructed wetlands are well-suited for wastewater treatment purposes., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: To investigate the endocrine profile, body composition, and state of mood in male Olympic athletes participating in sports that do or do not emphasize leanness., Design: Cross-sectional study., Setting: Research unit at a university hospital., Participants: Forty-four Swedish male Olympic athletes participating in 26 different sport disciplines., Main Outcome Measures: Body composition was determined by dual-energy x-ray absorptiometry, and blood levels of steroid hormones and biomarkers of nutritional status were analyzed. In addition, states of mood were assessed employing the profile of mood states (POMS) test. The athletes were divided into 2 groups on the basis of whether their sporting discipline emphasized leanness or not., Results: In all subjects, body composition, hormone levels, and POMS scores were within normal ranges. However, the leanness athletes (n = 18) displayed significantly lower proportion of body fat (P < 0.01), higher spinal bone mineral density (P < 0.05), lower serum levels of free testosterone and leptin (P < 0.05), and higher serum levels of insulin-like growth factor binding protein 1 (P < 0.05) than nonleanness athletes (n = 26). Leanness athletes also had higher POMS scores for depression and anger, and a higher global POMS score (P < 0.05), the latter being positively correlated to the frequency of illness (r = 0.42, P < 0.01) before the Olympic Games., Conclusion: Although there were no indications of energy deficiency or endocrine disturbance in the leanness athletes, their higher POMS scores and frequency of illness may indicate the potential harmfulness of their pursuit of outstanding athletic performance.

Aims: To investigate the perceived impact of oral health-related quality of life problems in individuals with Ehlers-Danlos syndrome., Methods: Members of the Swedish Ehlers-Danlos Syndrome Association completed the Oral Health Impact Profile (OHIP-14). Of the 250 participating individuals, 223 were women, and they were the main focus of the analyses. The results were compared with a previous study of the oral health impact on quality of life in the Swedish population. Statistical methods used for comparison were the Student t and chi-square tests., Results: The mean OHIP-14 value for the entire Ehlers-Danlos syndrome group was 11.1. The mean for women was 11.8, which was significantly higher than 6.8 of the comparison group. The OHIP-14 score varied among age groups, and the highest mean value was found in the age group between 56 and 65 years of age. The most statistically significant differences between the subjects with Ehlers-Danlos syndrome and the comparison group were found for OHIP items 3, 4, and 8: "I have had pain in the mouth," "I have had discomfort when eating," and "I have been forced to interrupt meals.", Conclusion: It is well-known that Ehlers-Danlos syndrome has a considerable impact on health-related quality of life, and this study is the first to reveal that women with Ehlers-Danlos syndrome report a low oral health-related quality of life as measured with the OHIP-14. Dimensions that were particularly relevant were physical pain, psychologic discomfort, and handicap.

Dairy cow longevity combines all functional traits and is thought to be especially important in organic production, which is an established, increasing part of Swedish dairy production, representing approximately 6% of the market. The aim of this study was to compare dynamics in culling reasons between organic and conventional production and to analyze genotype by environment interactions for longevity. The data contained information from all organic herds with information available from official recording (n=402) and from approximately half of the conventional herds (n=5,335). Records from Swedish Holsteins (n=155,379) and Swedish Red cows (n=160,794) that had their first calf between January 1998 and September 2003 were included. The opportunity period for longevity was at least 6 yr. Six longevity traits were defined: length of productive life; survival through first, second, and third lactations; fertility-determined survival; and udder health-determined survival. Twenty codes were used to describe the cause of culling, and these were divided into 8 groups: udder health, low fertility, low production, leg problems, metabolic diseases, other diseases, other specified causes, and unspecified cause. The main reason for culling cows in organic herds was poor udder health, whereas for cows in conventional herds it was low fertility. Furthermore, the shift in main culling reason from fertility, which was most common in first lactation regardless of production system, to udder health occurred at a lower age in organic production. Heritabilities and genetic correlations for the longevity traits expressed in organic and conventional herds were estimated from a bivariate animal model. The genetic correlations were close to unity (>0.88), except for fertility-determined survival in the Swedish Red breed (0.80). Heritabilities were low to moderate, and no clear pattern was identified for production system or breed. In general, the results indicate that farmers' culling criteria differ between organic and conventional production. Different preferences may influence the need for alternative selection indexes for organic production, with different weightings of traits, or a separate breeding program. However, no genotype by environment interaction of importance was found between the production systems., (Copyright © 2011 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.)

Rationale and Aims: To evaluate the extensive use of peripheral venous catheters (PVCs), including catheter-related complications, a reliable tool for PVC assessment is needed. The aim of this study was to develop such a tool to evaluate PVCs in relation to management, documentation and signs and symptoms of thrombophlebitis (TH), as well as to determine its inter-rater and test-retest reliability., Method: The tool development included confirmation of content and face validity. Two groups of registered nurses used the new tool (PVC assess) to assess PVC management and signs of TH independently. Group A (n=3) assessed 26 items in 67 PVCs bedside (inter-rater reliability). Group B (n=3) assessed photographs (67 PVCs, 21 items) of the same PVCs as those in Group A with a 4-week interval (test-retest reliability). Proportion of agreement P(A) and Cohen's kappa were calculated to evaluate inter-rater and test-retest reliability., Results: Among nurses assessing PVCs at bedside, the P(A) was good to excellent (0.80-1) in 96% of the items in PVC assess. In 80% of the items kappa was substantial to almost perfect (0.61-1). TH sign erythema fell into the fair range (kappa=0.40). In test-retest reliability analysis the P(A) was within the good and excellent range (0.80-1.0) and kappa varied from moderate to almost perfect (0.41-1.0) in 95% of the items. One item 'outer dressing is clean' was in fair range (0.21-0.40)., Conclusions: The PVC assess instrument shows satisfactory inter-rater and test-retest reliability. Reliability tests on reviewing documentation remain to be performed., (© 2009 Blackwell Publishing Ltd.)

Background: Optimization of body weight and composition is a key priority for elite athletes striving for a competitive advantage. The present investigation was designed to characterize various parameters related to weight control in Olympic competitors., Design: Cross-sectional study., Setting: Research unit at a University Hospital., Participants: 223 athletes (125 men and 98 women, with only 1 drop-out), all members of the Swedish teams participating in the Olympic Games of 2002 and 2004., Main Outcome Measurements: Self-reported body weight and height, from which BMI was calculated, variation in weight during the year prior to Olympic competition, and self-reported weight control strategies by questionnaire. The athletes were divided into two groups on the basis of whether their sporting discipline emphasized leanness or not., Results: The athletes participating in disciplines that emphasize leanness demonstrated a lower mean BMI (22.7 +/- 2.7 vs 3.7 +/- 2.3 for nonlean athletes, P < 0.05), greater variation in weight (5.3% vs 4.7%, P < 0.05), more frequent attempts to lose weight (P < 0.001), longer total training time (P < 0.001), a higher training load yet weighed more than they desired at the time of competition. These differences were most evident in male athletes. Furthermore, 9.4% of lean athletes reported previously suffering from an eating disorder, in comparison to 2.7% of the nonlean athletes (P < 0.05). More athletes in disciplines emphasizing leanness also reported being ill during the prior 3 month period (38.5% vs 21.6%, P < 0.05)., Conclusions: This investigation reveals that the weight control practices employed by Olympic athletes participating disciplines that emphasize leanness appear to be suboptimal. Counseling concerning weight control could be used as a tool to prevent illness and enhance performance.

Manipulation of the blood's oxygen carrying capacity (CaO(2)) through reinfusion of red blood cells, injections of recombinant erythropoietin or by other means results in an increased maximal oxygen uptake and concomitantly enhanced endurance performance. Therefore, there is a need to establish a system--"A Blood Pass"--through which such illegal and unethical methods can be detected. Venous blood samples were taken under standardized conditions from 47 male and female Swedish national and international elite endurance athletes four times during the athletic year of the individual sport (beginning and end of the preparation period and at the beginning and during peak performance in the competition period). In these samples, different hematological values were determined. ON(hes) and OFF(hre) values were calculated according to the formula of Gore et al. A questionnaire regarding training at altitude, alcohol use and other important factors for hematological status was answered by the athletes. There were some individual variations comparing hematological values obtained at different times of the athletic year or at the same time in the athletic year but in different years. However, the median values of all individual hematological, ON(hes) and OFF(hre), values taken at the beginning and the end of the preparation or at the beginning and the end of the competition period, respectively, as well as median values for the preparation and competition periods in the respective sport, were all within the 95% confidence limit (CI) of each comparison. It must be mentioned that there was no gender difference in this respect. This study shows that even if there are some individual variations in different hematological values between different sampling times in the athletic year, median values of important hematological factors are stable over time. It must be emphasized that for each blood sample, the 95% CI in each athlete will be increasingly narrower. The conclusion is that there is a physiological basis for establishing an individual-based "Blood Pass" system, mainly for athletes competing at the international level. On indications of manipulations of hemoglobin concentration and red cell mass by deviations from established "Blood Pass" data, more specific methods can be applied.

The incidence of normal and atypical progesterone profiles in Swedish dairy cows was studied. Data were collected from an experimental herd over 15 yr, and included 1,049 postpartum periods from 183 Swedish Holstein and 326 Swedish Red and White dairy cows. Milk progesterone samples were taken twice weekly until initiation of cyclical ovarian activity and less frequently thereafter. Progesterone profiles were 1) normal profile: first rise in milk progesterone above the threshold value before d 56 postpartum, followed by regular cyclical ovarian activity (70.4%); 2) delayed onset of cyclical ovarian activity: low milk progesterone the first 56 d postpartum (15.6%); 3) cessation of cyclical ovarian activity: ovarian activity resumed within 56 d postpartum, but ceased for a period of 14 d or more (6.6%); and 4) prolonged luteal phase: ovarian activity resumed within 56 d postpartum, but milk progesterone remained elevated in the nonpregnant cow for a period of 20 d or more (7.3%). Swedish Holsteins had 1.5 times higher risk of atypical profile than Swedish Red and Whites. Risk of atypical profiles was 0.5 and 0.7 times lower for older cows compared with first-parity cows; 2.3 times higher for cows in tie-stalls compared with those in loose housing; 2.6 times higher for cows calving during winter compared with summer; 0.5 times lower for cows in earlier (1994-1999) calving-year groups compared with the most recent (2000-2002); 2.5 times higher for cows with planned extended calving interval compared with conventional calving interval; and 2.2 times higher for an atypical profile in previous lactation compared with a normal profile. Cows with atypical profiles had a 15-d increase in interval from calving to first artificial insemination and an 18-d increase in interval from calving to conception. Progesterone samples taken within the first 60 d postpartum were used to calculate the percentage of samples above the threshold value of luteal activity. This measure had a significantly different mean in profiles and can be used to separate delayed onset of cyclical ovarian activity profiles and prolonged luteal phase profiles from normal. Thereby, it may be a more effective tool than measurements based only on the onset of ovarian cyclical activity in genetic evaluation of early postpartum fertility in dairy cows.

Questionnaire studies were conducted in a residential area before and after the erection of a 2.25 m high noise barrier of conventional type along a heavily traveled road (19,600 vehicles/24 h). The interval between studies was two years. Houses closest to the barrier received a sound-level reduction from -70.0 to 62.5 dB Lden at the most exposed facade. The sound-level reduction decreased with distance to the road, and was negligible for houses at more than 100 m distance. Up to this distance, the noise barrier reduced residents' noise annoyance outdoors and indoors as well as improved speech communication outdoors. Indoors, speech communication and sleep disturbance were slightly but nonsignificantly improved. Predictions of the number of annoyed persons from published exposure-response curves (in Lden) agreed with the percentage of residents being annoyed when indoors, before and after the barrier. Conversely, the percentage of residents being annoyed when outdoors clearly exceeded the predictions. These results suggest that these exposure-response curves may be used in predicting indoor situations, but they should not be applied in situations where outdoor annoyance is at focus.

Ehlers-Danlos syndrome (EDS) is a relatively rare, inherited connective tissue disorder and skin hyperextensibility, joint hypermobility, chronic joint and limb pain, blood vessel and tissue fragility are frequent symptoms. The aims of this study were to describe the degree to which individuals with EDS accept and cope with perceived limitations related to the syndrome, and to determine the relationships between acceptance of disability (AD), sense of coherence (SOC), functional health status and background data. Four questionnaires were mailed: the AD scale Modified (ADM), the SOC Scale, the Sickness Impact Profile (SIP) and a background form. The respondents with EDS were recruited through the EDS National Association in Sweden and the response rate was 74% (69 females and eight males). The Ethical Committee at Huddinge University Hospital (ref. no. 152/95) approved the study. This study has shown that the level of AD and SOC in individuals with EDS is similar to other patient groups, e.g. individuals with ostomy and with diabetes. Further, the SOC was in concordance with that of the general population. Those working full-time accepted their disability to a greater degree than those on sick leave or disability pension. A multiple regression analysis showed that a greater AD was associated with a higher level of SOC and a better functional health status. The SOC and SIP together accounted for 50% of the variance in the ADM. For health promotion in nursing practice it is important to have insight into the problem areas which may influence the overall life situation for an individual with EDS. A key issue for nurses is to identify individuals with low acceptance of their disease and/or low SOC in order to support these persons' adaptation process. Future research on EDS may be directed towards projects focusing on the development and implementation of models to strengthen the level of AD and SOC in this group.

In Swedish Holstein dairy cattle, genetic effects on stillbirth and calving difficulty were studied in 411,409 first- and 281,193 second-calvers. A linear single-trait sire-maternal grandsire model and a threshold model using a Gibbs sampling technique were used to analyse calving data from 1985 to 1996. In first calving when using the linear model, the heritability of stillbirth on the visible scale was 4% for the direct effect and 3% for the maternal effect. For calving difficulty it was 6% and 5% for direct and maternal effects, respectively. In second calving the corresponding heritabilities for the two traits were considerably lower, less than 1%. Adjusting for calving difficulty in linear analysis of stillbirth halved the heritabilities for the direct and maternal effects in first calving. When using a threshold model, heritabilities for stillbirth in first-calvers were 12% and 8% for direct and maternal effects, respectively, and for calving difficulty they were 17% and 12%. At second calving corresponding heritabilities were 2 to 4% for stillbirth and 4 to 7% for calving difficulty. The correlation between direct and maternal effects was around -0.1, irrespective of whether the linear or the threshold model was used for first-calvers. The genetic correlations between bulls' EBV from first and second calving were 0.4 to 0.5 for direct and maternal effects in stillbirth, whereas they were 0.6 to 0.7 for calving difficulty. In first-calvers there was a substantial genetic variation in both traits, expressed by differences between breeding values of bulls, despite fairly low heritability. The results obtained in this study suggest that first-parity records should preferably be used for genetic evaluation of bulls for calving performance. In such routine evaluations both stillbirth and calving difficulty, and both direct and maternal effects, should be included.

This study was initiated due to the observation of increasing and rather high levels of stillbirths, especially in first-calving Swedish Holstein cows (10.3%, 2002). Seventy-six Swedish Holstein calves born to heifers at 41 different farms were post mortem examined in order to investigate possible reasons for stillbirth and at what time in relation to full-term gestation they had occurred. The definition of a stillborn calf was dead at birth or within 24 h after birth after at least 260 days of gestation. Eight calves were considered as having died already in uterus. Slightly less than half of the examined calves (46.1%) were classified as having died due to a difficult calving. Four calves (5.3%) had different kinds of malformations (heart defects, enlarged thymus, urine bladder defect). Approximately one third of the calves (31.6%) were clinically normal at full-term with no signs of malformation and born with no indication of difficulties at parturition or any other reason that could explain the stillbirth. The numbers of male and female calves were rather equally distributed within the groups. A wide variation in post mortem weights was seen in all groups, although a number of the calves in the group of clinically normal calves with unexplained reason of death were rather small and compared with e.g. those calves categorised as having died due to a difficult calving, their average birth weight was 6 kg lower (39.9 +/- 1.7 kg vs. 45.9 +/- 1.5 kg, p < or = 0.01). It was concluded that the cause of stillbirth with a non-infectious aetiology is likely to be multifactorial and difficult calving may explain only about half of the stillbirths. As much as one third of the calves seemed clinically normal with no obvious reason for death. This is a target group of calves that warrants a more thorough investigation in further studies.

Purpose: Practical aspects and impact on daily life of short bowel syndrome (SBS) and an ostomy were explored in people with SBS. Interest was focused on nutrition and excretion, ostomy problems, associated medical and surgical problems, socioeconomic situation, and social and leisure activities., Subjects and Setting: Six subjects (range, 38-68 years) with Crohn's disease were included from the University Short Bowel Clinic at Sahlgrenska University Hospital, Gothenburg, Sweden. Average disease duration was 25 years, and mean small intestinal length was 107 cm; 4 subjects were receiving parenteral nutrition at home., Methods: Subjects were interviewed in their homes using a semistructured interview divided into the areas of focus. Data were transcribed by shorthand and were rewritten into the computer the same day. A questionnaire on nutrition and excretion was answered by the subjects in writing and mailed to the interviewer., Results: The most significant observation was the limited ability to act spontaneously, because all daily activities involved considerable planning. Three subjects said they had never accepted the ostomy; the others would not return to their pre-stoma lifestyle. The 2 subjects with a colostomy described special emptying patterns that caused limitations in social life that had not been reported previously. Fistulas were reported as having been the most trying part of the disease. Three subjects worked part time, which was of utmost importance for quality of life. Fatigue influenced social and leisure activities., Conclusion: People with SBS are bothered by a number of demanding problems in various aspects of life. Therefore, a team approach toward care is critical to allow for coordination of action toward the various needs. It also seems unlikely that standard instruments of quality of life can capture the complicated situations with which these subjects live. It appears that coping mechanisms also need to be considered.

Aim: To determine how nurses experience the functions of hospital beds and the bedside equipment when performing specified common nursing tasks., Background: The hospital bed is an important working tool for the nursing staff but few studies have focused on hospital beds at acute wards., Method: Data was collected with questionnaires answered by 74 registered and enrolled nurses from three Departments., Findings: The bed was frequently used when performing nursing tasks with patients in bed, but the manoeuvring features were difficult to adjust, resulting in unsatisfactory working postures. Transporting the patient in bed and cleaning of the bed were the most troublesome tasks. The bed clothes were often experienced as unsatisfactory for their patients., Conclusions: The beds have serious deficiencies. It is imperative to improve them, as a good physical milieu positively influences the working conditions of the staff.

Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder, primarily affecting the skin, ligaments, joints and blood vessels. The symptoms can vary from undiagnosed cases with mild symptoms to more severe forms. A qualitative study was conducted with the purpose of exploring how individuals with different symptoms of EDS describe their symptoms and perceive their daily life. Eleven interviewees were recruited via a support group in Sweden. The main strategies of the grounded theory method were used in collection and analysis of data. The identified main theme, "Living a restricted life", seemed to explain the way in which fears, pain, stigmatisation and experiences of non-affirmation in health-care limited the possibility of self-actualisation in daily living and social life. This study provides a conceptual framework for future research and an understanding of the type of professional support individuals with EDS require.

To gather information regarding how to best assist liver transplant recipients in improving their self-care capacity and well-being, we investigated their total health situation. A retrospective, cross-sectional survey with up to a 10-year follow-up concerning experienced health and quality of life after liver transplantation (LTX) was conducted. The aim of this study was to provide descriptive data on the experienced health and health-related quality of life (HRQOL) after LTX and to evaluate whether the pretransplantation medical conditions affected these parameters. All patients who had undergone LTX, were alive at the time of the study, and had a follow-up of more than 6 months (n = 134) were asked to complete three self-administered questionnaires. The response rate was 95% (n = 120). There was no correlation between pretransplantation Child-Pugh score and HRQOL after LTX. Liver transplant recipients were more limited in their physical health than healthy subjects but were equal in social functioning and mental health. Twenty-six percent suffered from severe bodily pain. A significant difference was reported in all health areas, with the exception of vitality and social functioning, between employed and unemployed transplant recipients. Liver transplant recipients suffered from limited physical functioning many years after transplantation. Their social functioning and mental health were not negatively affected. This study emphasizes that bodily pain and difficulties in performing regular activities because of physical illness are problems frequently experienced by liver transplant recipients., (Copyright 1998 W.B. Saunders Company.)

Effects on reproduction in a total of 135 dairy cows managed for calving intervals of 12, 15 or 18 months (72, 38 and 25 cows respectively) were studied. The cows were of the Swedish Red and White Breed (SRB) and the Swedish Freisian Breed (SLB) and were housed in 2 different herds with 3 different management systems (tied, loose, and tied but milked in a milking parlour; mixed). The cows in one of the herds (48 cows) were assigned for milking either 2 times or 3 times a day. When comparing conception rate at 1st insemination (AI) and the percentage of cows finally pregnant, we found no significant differences between the 3 calving interval groups, however, a tendency for a higher conception rate with a 15 months' interval compared with a 12 months' interval was found in one of the herds (50% vs 41.5%). The percentage of finally pregnant animals varied between 81% and 100%, but this variation was mainly attributed to the herd rather than calving interval group. A significantly higher percentage of cows was treated for anoestrous in the 12-month group than in the 15-month group in one of the herds (28.6% vs. 5.3%). The frequency of ovulations with external heat signs increased with ovulation number up to the 4th ovulation and thereafter remained stable. No significant difference was found in number of AIs required per conception with respect to calving intervals, breeds, or milking frequency groups. However, cows milked 3 times a day had a significantly longer interval from the 1st AI to conception compared with cows milked 2 times a day (45.8 days vs 17.6 days, p < .01). Cows kept loose exhibited 1st ovulatory oestrous, approximately 2 weeks earlier (55.9 days vs 69.7 days, p < .05) than their herd mates kept tied. In conclusion, our study shows that lengthening the calving interval to 15 or 18 months may have a positive influence on reproduction in terms of less need for treatments of ovarian disorders and higher conception rates. Our results also indicate that milking 3 times a day may have negative effects, and keeping cows in a loose-housing management system may have positive effects on ovarian function.

Objectives: To study the effects of advice on diet, exercise and their combination on oral glucose tolerance (OGTT), insulin secretion, insulin-like growth factor-1 (IGF-1) and its binding protein, IGFBP-1., Design: A 6-month, randomized, controlled intervention study., Setting: Primary health care centres in Sollentuna, Stockholm and the Department of Medicine, Karolinska Hospital, Stockholm, Sweden., Subjects: One hundred and fifty-seven normoglycaemic healthy men, mean age 46 years, range 35-60 years, with slightly to moderately raised cardiovascular risk factors., Interventions: Advice on diet (D, n = 40), exercise (E, n = 39) a combination of both (DE, n = 39) and a control group (C, n = 39)., Main Outcome Measures: An OGTT, insulin secretion, IGF-1 and its binding protein, IGFBP-1., Results: The number of pathological OGTTs in the intervention groups decreased from 42/118 to 33/118 whilst the number in the control group did not change. Fasting insulin levels decreased in groups E and DE from 8.8-7.4 mU L-1 (P < 0.01) and from 8.3-6.7 mU L-1 (P < 0.01), respectively. Accordingly, the insulin area under the curve decreased from 5278 to 4828 (P < 0.05) in group E, and from 5482 to 4809 (P < 0.01) in group DE. IGF-1 only increased in group D. The most prominent changes were noted for IGFBP-1, which increased in all three intervention groups and to the highest degree in group DE (from 33.7-42.6 micrograms L-1, P < 0.001)., Conclusions: A combination of increased exercise and improved diet, as well as increased exercise alone, favourably affect glucose and insulin homeostasis in middle-aged men with moderately elevated cardiovascular risk factors. The most marked changes were noted for IGFBP-1, possibly suggesting a decreased insulin secretion and an enhanced insulin sensitivity.

Background: Factors associated with attending screening for colorectal cancer with faecal occult blood testing was studied., Methods: Sixty-eight per cent of 34,144 subjects participated in the primary screening and/or rescreening in a randomized screening study. The mortality and causes of death in the two groups were studied. A sample of the subjects received a questionnaire, in which they were asked about their reaction to the invitation. A statistical sample was called for a telephone interview., Results: The mortality among the non-attenders was higher than among the attenders (p < 0.001), which might reflect a higher morbidity among the non-attenders. The mortality was equal in the test and control groups. There was no difference among the attenders and non-attenders who had a full or 50% pension. Among immigrants the attitude to screening was less positive among those born in 1918 but was the same as that of the whole group among those born in 1929. Significantly fewer persons among the non-attenders than among the attenders could be reached for a telephone interview (p < 0.001)., Conclusion: There is a possibility that the compliance can be increased. The non-attenders' attitude to screening was more negative than that of the attenders.

Unlabelled: The purpose of the present investigation was to monitor psychological changes using the Profile of Mood States (POMS) test on 14 (9 men and 5 women) world-class canoeists. A Swedish version of the POMS questionnaire and a rating questionnaire on the training load (RTL) were administered weekly from May until the beginning of August 1992., Results: The total mood score of the POMS was initially 130 +/- 15.7 (mean +/- SD) and improved (P < 0.05) to 122 +/- 23.1 (mean +/- SD) a month later. During the following heavy training, the total mood score of the POMS increased significantly (P < 0.01) to 160 +/- 27.2 (mean +/- SD). In the tapering period, there was a significant improvement in mood state (P < 0.01) down to a total mood score of the POMS of 120 +/- 22.1 (mean +/- SD) 1 wk before the Olympics. The RTL (mean +/- SD) on the same occasions was 9.4 +/- 1.9, 9.3 +/- 2.9, 11.6 +/- 1.5, and 7.3 +/- 2.1, respectively. Elevated POMS total mood disturbance scores (elevation > 50%) were used as a criterion for determining whether the athletes were training excessively (or developing staleness). This criterion was fulfilled in 12% of all POMS assessments in nine of the subjects. It is concluded that the monitoring of psychological mood disturbances is useful in reducing the risk of staleness in canoeists undergoing hard training. Titration of the training stimulus on the basis of POMS scores resulted in none of the canoeists developing signs of staleness in connection with the Olympics.

The main aim of the present study was to adapt an instrument measuring patients' adjustment to life with an ostomy to Swedish conditions and to test reliability and validity of the adapted instrument. The Ostomy Adjustment Scale (OAS), which is focused on three domains: physical function, psychologic state, and social interaction, was selected as suitable. After translation into Swedish, equivalence and internal consistency of the scale were calculated. Subjects with various types of urine or faeces diversions were recruited for self-rating with the OAS and a visual analogue scale estimating total quality of life (QOL). The instruments were tested in 48 patients with five different diagnoses, 36 with and 12 without ostomy, and re-tests were carried out in 25 of the patients. Reliability (Cronbach's alpha) was 0.95. A positive correlation was found between the OAS and QOL (r = 0.67), indicating that the instrument has some validity.

Objective: To integrate prevention of cardiovascular disease within the primary health care., Design: A prevention programme which combines population and individual high-risk strategy., Setting: The Primary Health Care in Sollentuna, Stockholm, Sweden., Main Outcome Measure: Characteristics of, and risk factor prevalence among, persons registered in the prevention programme., Results: During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15-60 years, were registered in the prevention programme. 90% were < or = 60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol > or = 5.2 mmol/l, and 33% and 22% had a diastolic blood pressure > or = 90 mmHg., Conclusion: The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.

Enterobacter cloacae strains dominated the aerobic faecal flora of 8.3% of 953 infants discharged from 32 Swedish neonatal intensive care units and the susceptibility of these strains to seven beta-lactam antibiotics was determined. Isolates from infants treated with cefuroxime showed slightly increased MICs only to ampicillin, cephalexin and cephalothin as compared to isolates from untreated infants matched for ward and time of sampling (P = 0.02). In contrast, E. cloacae isolates from ampicillin treated infants showed markedly elevated MICs of all agents tested including piperacillin, cefuroxime, cefotaxime and ceftazidime as compared to those from control neonates (P values between 0.001 for ampicillin and 0.017 for cefotaxime). Thus, E. cloacae with cefotaxime MICs as high as 512 mg/L were isolated only after ampicillin therapy. The resistant strains were negative in a colony DNA hybridization assay using gene probes for the plasmid beta-lactamases TEM-1, OXA-1 and SHV-1. The resistant strains also showed only one beta-lactamase band when crude cell sonicates were analysed by isoelectric focusing, and were not found in other infants in the same ward. The results indicate that the selection of chromosomal E. cloacae mutants, presumably with stably derepressed beta-lactamase production, in the faecal flora of neonates is rare during treatment with cefuroxime and more common during ampicillin therapy.

Gram-negative bacteria are an important cause of invasive infection among neonates. In this study a novel fingerprinting method was used for the first time to assess the importance of various potential reservoirs of the major gram-negative enterobacteria that colonized 46 consecutive infants in three neonatal special care units during a three to four week period. Such bacteria were isolated from the oropharynx, umbilical cord and faeces in 24%, 33% and 100% of the infants, respectively. Klebsiella/Enterobacter spp. dominated over Escherichia coli and spreading (shared) over sporadic strains. Sixty-one percent of the neonates were colonized with at least one and up to six different strains shown to exist in the ward, mainly in other infants. Environmental reservoirs and the faecal flora of mothers and staff were of minor importance. Vertical transmission occurred in 12% of vaginally delivered infants and in 0% of those delivered by caesarean section.

Both ampicillin and cefuroxime therapy of neonates selected drug- and species-dependent beta-lactam resistance patterns in fecal strains of Escherichia coli and Klebsiella spp. This was in contrast to our previous findings that ampicillin, but not cefuroxime, contributed to the emergence of beta-lactam resistance also by the promotion of nosocomial spread of resistant strains.

The aerobic faecal flora of 953 infants aged over 5 days was studied on discharge from 22 neonatal wards in Swedish hospitals. Klebsiella/enterobacter was isolated from 74% of infants and dominated the aerobic gram-negative flora in 19 wards. Escherichia coli was carried by 42% and showed a slight dominance in two wards. Initially klebsiella/enterobacter dominated the flora but became increasingly mixed with and taken over by E. coli, carriage increasing from 21% in infants discharged after 5-7 days to 57% after 3 weeks or later. Among infants with E. coli, P-fimbriated strains were demonstrated in 23% (range 0-67) and were independent of age. Occasional clustering of such strains was observed in 3/22 wards during the study period. It is postulated that the general and local colonization patterns observed reflect differences between individual strains of E. coli and klebsiella in both their capacity for transmission and their persistence in the newborn gut. The role of P-fimbriae in intestinal colonization of neonates by E. coli was, however, not supported.