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Therese Dwyer Løken, Marit Kristine Helgesen, Catharina Bjørkquist Faculty of Health, Welfare and Organisation, Østfold University College, Halden, NorwayCorrespondence: Therese Dwyer Løken, Østfold University College, Post Box 700, Halden, 1757, Norway, Tel +47 92062944, Email therese.d.loken@hiof.noPurpose: Fragmentation in health and social care services can result in poor access to services, lack of continuity and inadequate provision for needs. A focus on integration of services are thus suggested to prevent negative consequences of fragmentation for service recipients. There are, however, few studies that explore the competence needed for integration of services in municipal health and social care organizations. This study explores which types of competence stakeholders require and how collective competence can promote service integration.Methods: This is a single-case study, and the data consist of focus group interviews and individual interviews with service recipients, family caregivers, professionals and managers. The data were analysed both inductively and deductively.Results: The analysis resulted in four main themes: 1) Knowledge about individual life situations and organization and system, 2) investigation competence, 3) person-centred collaboration competence and 4) facilitating competence. The themes form the basis for a collective competence framework that can promote service integration.Conclusion: As service integration involves a high degree of interlinked activities between professionals and organizational units, a collective approach to the concept of competence is presumably applicable. When service integration competence is approached as a collective attribute of a network within and between organizational units, the organization can facilitate this competence by encouraging an active exchange of knowledge between professionals. We also argue that service integration competence increases connectivity and interdependency between professionals and organizational units, and includes service recipients and family caregivers as legitimate extra-professional parts of the collaborative network.Keywords: fragmentation, care coordination, interdependency, extra-professional involvement, health and social services, municipal services

The intention of this collaborative project was eradication of pestivirus from the Norwegian cattle population of about 30,000 dairy and beef herds, primarily by identification and culling of persistently infected (PI) animals. Testing was performed in four tiers, with examination for pestivirus antibodies by indirect ELISA in (1) bulk milk, (2) pooled milk from primiparous dairy cows and (3) pooled blood from young stock. The herds positive in the third tier were examined for pestivirus antigen in blood from all antibody-negative individuals by antigen- capture ELISA, and these animal composed tier (4). Following culling of the PI animals, a herd was considered free from pestivirus when pooled blood from young stock was antibody-negative on two sampling occasions three months apart. Number of herds with PI animals peaked at about 3000 (10 per cent) in the 2nd project year, then decreased steadily; only three herds (0.01 per cent) contained PI animals 10 years later. Solid, continuous information flow to all relevant partners was crucial to project success. The project saved losses of between 50 million and 200 million Norwegian crowns (NOK) annually (approximately 4.5 million to 18 million GBP). Project running costs for 10 years were 52.4 million NOK. Following project completion, surveillance of the Norwegian cattle population for pestivirus has continued. [ABSTRACT FROM AUTHOR]

There is often a need to reduce sample size in clinical trials due to practical limitations and ethical considerations. Better comparability between treatment groups by use of stratification in the design, and use of continuous outcome variables in the evaluation of treatment results, are two methods that can be used in order to achieve this. In this paper the choice of stratification factors in trials of clinical mastitis in dairy cows is investigated, and two score-scales for evaluation of clinical mastitis are introduced. The outcome in 57 dairy cows suffering from clinical mastitis and included in a clinical trial comparing homeopathic treatment, placebo and a standard antibiotic treatment is investigated. The strata of various stratification factors are compared across treatments to determine which other factors influence outcome. The two score scales, measuring acute and chronic mastitis symptoms, respectively, are evaluated on their ability to differentiate between patients classified from clinical criteria as responders or non-responders to treatment. Differences were found between the strata of the factors severity of mastitis, lactation number, previous mastitis this lactation and bacteriological findings. These factors influence outcome of treatment and appear relevant as stratification factors in mastitis trials. Both score scales differentiated between responders and non-responders to treatment and were found useful for evaluation of mastitis and mastitis treatment. [ABSTRACT FROM AUTHOR]

Summary Twenty-two heifers were infected intranasally with non-cytopathic bovine viral diarrhoea virus (BVDV) between days 74 and 82 of pregnancy. All animals had developed serum antibodies against BVDV 5 weeks later. No clinical effects were seen in the heifers, and they all delivered a live calf. The newborn calves were generally small, appeared unthrifty as typical ‘poor doers’, and some developed secondary infections with diarrhoea and signs of respiratory disease. Eighteen of the 22 calves were born without antibodies against BVDV and were persistently infected (PI) with the virus. One was weak at birth and died the following day. Four calves were born with serum antibodies against BVDV and with no detectable virus. Three of these showed signs and/or pathological changes indicating disease in the central nervous system. Otherwise, there were no obvious clinical differences between these calves and the PI calves, nor were there any apparent significant differences in blood parameters between these groups. In general, the calves showed low γ -globulin values and thrombocytopaenia, but moderately increased fibrinogen values and relatively normal lymphocyte numbers. [ABSTRACT FROM AUTHOR]

Alternative therapy of animals is described, in the meaning of alternatives to veterinary therapy traditionally accepted by veterinary faculties and schools and included in their curricula. Alternative therapy composes of different disciplines, of which homeopathy is emphasised in this presentation. Information is given on the use and interest of such therapy among veterinarians and animal owners. Homeopathy as other alternative therapies, may offer great advances, if they induce any effect. Some of the disciplines are based on a scientifically accepted documentation. Others, and homeopathy in particular, are missing such a documentation of effect. The justification of including alternative therapy in treating animals is discussed. Research in alternative therapy of animals is greatly needed, in particular to evaluate therapeutic methods which are in extensive use without any documented effect. An ongoing research project in Norway on the effect of homeopathic treatment of mastitis in cows is shortly presented.

A cross sectional study was conducted during October and November 2006 on 69 small-holder dairy farms with lactating cows in Mvomero and Njombe districts Tanzania, to determine the prevalence of mastitis and to assess the milk quality on the study farms. Clinical mastitis was investigated using clinical changes of udder and milk at animal level. Cow-side California Mastitis Test (CMT) and microbiological cultures were used to assess subclinical mastitis at quarter level. Milk quality was determined on bulk milk samples at herd level using alcohol and acidity tests, butter fat content, total solids, ash content as well as Delvotest® for antimicrobial residues. Overall prevalence of clinical mastitis at herd level in both districts was 21.7 % (n = 69). Based on CMI, prevalence of subclinical mastitis at animal level was 51.6 % (n = 91). Prevalence of bacterial isolates at animal level was 35.2 % (n = 91) while' for fungal it was 16.7 % (n = 90). Based on CMT results, prevalence of subclinical mastitis at quarter level was 30 % (n = 353), while for bacteria and fungi it was 16% and 6% respectively. Contamination of milk with antimicrobial residues was 4.5% (n = 67). The milk quality parameters for most of the milk samples were within acceptable levels. Findings in this study have demonstrated high prevalence of subclinical mastitis that may contribute to low productivity of dairy cattle in both districts. About 20% of CMT subclinical cases had no involvement of microbial pathogens that suggested the need for minimal interventions with antimicrobial agents. These findings call for use of udder disinfectants and improved milking hygiene as intervention strategies to control mastitis on the small-holder dairy farms in Tanzania. [ABSTRACT FROM AUTHOR]

A study was undertaken to investigate Cryptosporidium infection in crossbreed dairy calves in two districts in Tanzania. A total of 943 fecal samples from 601 dairy calves were included in the study, with calves from both smallholder dairy farms and from large-scale and medium-scale dairy farms. The modified Ziehl-Neelsen (mZN) technique was used to examine 710 samples, and 13 of these were considered to be positive for Cryptosporidium. These 13 samples considered positive by mZN, along with the remaining 233 samples, were analysed by immunofluorescent antibody test (IFAT). Of these 246 samples examined by IFAT, 15 samples, 10 of which were considered positive by mZN, were also examined by the auramine phenol technique, and 5 samples, all of which were considered positive by mZN, were analysed by PCR. The results from the IFAT, auramine phenol and PCR analyses demonstrated that none of the samples contained Cryptosporidium oocysts, indicating that, cryptosporidiosis is currently not a problem in dairy calves in these regions of Tanzania. These unexpected results are discussed with respect to other reports on cryptosporidiosis in calves that suggest that this parasite is a serious calf disease globally, and particularly in relation to studies from Tanzania. We suggest that results from studies of cattle in Tanzania, in which mZN has been used as the sole analytical method, should be treated with caution.

Smallholder farmers' knowledge and practice of dairy calf management on 129 farms with calves less than 10 months of age in Southeastern and Southern Highland areas of Tanzania was assessed. The method of study included both a farm visit and completion of a questionnaire. Most of the farmers were female, with a primary level of education, and majority kept 1-3 milking cows that yielded 6-10 l milk/cow/day. Most of the calves were fed milk using a residual calf suckling system. Weaning age was 3-8 months. Overall, the body condition of the calves was poor, ranged from 1 to 2.5 with a mode of 2. The majority of the farmers believed that helminthosis was the most common disease condition affecting the calves; diarrhea was ranked as the second. Calf death was reported by 20% of the farmers to have occurred in their herd lasting the 2 years prior to the study. Calf body condition score was related to body weight for calves younger than 9 weeks, and older than 23 weeks of age, whereas no such relationship existed in the age group 9 to 23 weeks. The sex distribution was skewed with less male calves being older than 23 weeks. We hypothesize that male calves experience inferior management compared with female calves. This study demonstrates a low level of knowledge on, and poor practices of calf management among the surveyed farmers that suggest the need for educational intervention.

Infection with Ovine herpesvirus 2 (OvHV-2) in healthy cattle, swine, sheep, and goats was investigated on 43 selected Norwegian farms; of which, 41 (95%) had experienced outbreaks of malignant catarrhal fever (MCF) in cattle and/or swine during the preceding 5 years. Two of the farms had no history of MCF and were included for control purposes. Blood samples from 384 cattle, 40 sows, 75 sheep, and 4 goats were examined for OvHV-2 by polymerase chain reaction assay (PCR) and for antibodies using a competitive inhibition enzyme-linked immunosorbent assay (ciELISA). All samples were also tested for antibodies reactive to Alcelaphine herpesvirus 1 with an indirect fluorescent antibody test (IFAT). All but 4 of the sheep and all 4 goats tested positive with 1 or more of the tests. Eighty-nine (25%) of the cattle and 17 (43%) of the swine on the farms with previous MCF outbreaks tested positive with 1 or more of the tests. On 22 of the farms, at least 1 bovine tested positive with ciELISA and/or PCR, whereas 8 other farms had test-positive cattle with IFAT only. The 2 control farms yielded no positive results with any of the tests. Four of the farms had swine that tested positive with PCR, but none with ciELISA, whereas 4 other farms had test-positive swine with IFAT only. The prevalence of infection in cattle and swine seemed not to be influenced either by their age or the degree of contact with the sheep and goats.

Based on the widespread use of homeopathy in treatment of animal disease and the poor documentation of its possible effects and consequences, a clinical trial was carried out in order to evaluate the efficacy of homeopathy in treatment of clinical mastitis in dairy cows and a design for clinical studies on homeopathic treatment, taking into account the guidelines for randomized-clinical trials (RCT) as well as the basic principles of homeopathy. A three-armed, stratified, semi-crossover design comparing homeopathy, placebo and a standardized antibiotic treatment was used. Fifty-seven dairy cows were included. Evaluation was made by two score scales, with score I measuring acute symptoms and score II measuring chronic symptoms, and by recording the frequencies of responders to treatment based on four different responder definitions. Significant reductions in mastitis signs were observed in all treatment groups. Homeopathic treatment was not statistically different from either placebo or antibiotic treatment at day 7 (P = 0.56, P = 0.09) or at day 28 (P = 0.07, P = 0.35). The antibiotic treatment was significantly better than placebo measured by the reduction in score I (P < 0.01). Two-thirds of the cases both in the homeopathy and placebo groups responded clinically within 7 days. The outcome measured by frequencies of responders at day 28 was poor in all treatment groups. Evidence of efficacy of homeopathic treatment beyond placebo was not found in this study, but the design can be useful in subsequent larger trials on individualized homeopathic treatment.

There is often a need to reduce sample size in clinical trials due to practical limitations and ethical considerations. Better comparability between treatment groups by use of stratification in the design, and use of continuous outcome variables in the evaluation of treatment results, are two methods that can be used in order to achieve this. In this paper the choice of stratification factors in trials of clinical mastitis in dairy cows is investigated, and two score-scales for evaluation of clinical mastitis are introduced. The outcome in 57 dairy cows suffering from clinical mastitis and included in a clinical trial comparing homeopathic treatment, placebo and a standard antibiotic treatment is investigated. The strata of various stratification factors are compared across treatments to determine which other factors influence outcome. The two score scales, measuring acute and chronic mastitis symptoms, respectively, are evaluated on their ability to differentiate between patients classified from clinical criteria as responders or non-responders to treatment. Differences were found between the strata of the factors severity of mastitis, lactation number, previous mastitis this lactation and bacteriological findings. These factors influence outcome of treatment and appear relevant as stratification factors in mastitis trials. Both score scales differentiated between responders and non-responders to treatment and were found useful for evaluation of mastitis and mastitis treatment.

Nineteen pregnant cows were experimentally infected with bovine viral diarrhoea virus (BVDV) between day 74 and 81 of pregnancy. All cows became infected and developed serum antibodies. Sixteen of the cows delivered persistently infected (PI) offspring, whereas the remaining three gave birth to calves with detectable serum antibodies and free from BVDV. The 16 cows with PI foetuses developed higher levels of antibodies in serum during pregnancy than did their three peers carrying non-PI calves. Multivariate analysis showed that the antibody levels in these two groups of cows were significantly different from day 135 of pregnancy. Foetal fluid was successfully collected from 18 of the 19 infected cows and from five uninfected control cows between 10 and 24 days before delivery by use of a percutaneous, blind puncture technique. No negative effects were observed in the cows or their offspring. BVDV was isolated and detected with an immunoperoxidase test in foetal fluid from 13 of the 16 cows carrying PI foetuses, and from 15 of the cows when a quantitative fluorescent polymerase chain reaction (PCR) technique was used. The negative sample in the PCR assay was positive for BVDV antibodies. The number of viral copies per microlitre in foetal fluids varied between 103 and 1080 in the positive samples. All samples taken from the cows carrying non-PI foetuses were negative for BVDV in both assays. In this experiment, examination of either serum or foetal fluids could identify the cows carrying a PI foetus. Examination of serum for BVDV antibodies was a reliable indicator of a PI foetus if the serum was collected during the last 2 months of pregnancy. For examination of foetal fluids, both viral and serological analyses should be performed. For viral analysis, PCR should be the test of choice. High levels of BVDV antibodies in conjunction with a negative result in the PCR may be indicative of a false-negative virus result. Further experience with the method of collection of foetal fluids is necessary for evaluation of its safety. Investigation of pregnant cows in order to discover a PI offspring before it is born could be a useful tool in control and eradication of BVDV.