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Cattle veterinarians have long been encouraged to take on a role as proactive health consultants. However, the process so far has been slow in Sweden and elsewhere, and only a rather small proportion of cattle work conducted by veterinarians involves veterinary herd health management (VHHM). The aims of this exploratory study were to explore Swedish cattle veterinarians' interpretation of VHHM services and to understand the factors that might affect the extent to which cattle veterinarians perform VHHM. Six focus group discussions with cattle veterinarians complemented with 5 individual telephone interviews with clinic managers were conducted in 2020. In total, 33 cattle veterinarians participated, all employed by the largest employer of Swedish cattle veterinarians: Distriktsveterinärerna (Swedish Board of Agriculture). Participants were chosen from 6 geographical regions with the aim to present variations in gender, age, country of education, proportion of dairy cattle work at the clinic, experience in the veterinary profession, and experience in work with dairy herds and in VHHM. The focus group discussions and interviews were recorded and these recordings were transcribed and analyzed thematically. Participants interpreted VHHM as work associated with the process of advising and included both ad hoc advising and more strategic forms of services. Prebooked visits per se were not seen as VHHM. We identified 4 different themes among the factors affecting the extent of VHHM services: (1) farmer trust and demand ; (2) veterinary competence ; (3) time available for VHHM ; and (4) the individual veterinarian's commitment and motivation. To gain farmers' trust and to create a demand for VHHM services, the results of VHHM work and the veterinarian's competence were deemed central by the participants. The veterinarians' skills in communication and relation building were considered especially important. Some farmers were perceived as having little interest in, or lacking deeper knowledge about, VHHM services. The promotion of VHHM services was mentioned as an important factor to increase farmer demand. Participants described VHHM as work demanding high skills and continuous capacity development. Veterinarians' personal commitment and motivation were also described as important for the extent to which VHHM services were performed. This was in turn affected by the psychosocial work environment (e.g., workload, interest and recognition from farmers and managers, and acceptance, priority, and support by colleagues and managers). Clinic managers had a central role in the extent to which VHHM services are offered by an individual veterinarian due to their responsibility for staff scheduling, which highly affects the conditions for capacity development, intercollegiate networking, and cooperation. Lack of time was a major barrier for VHHM. On-call duty time and subsequent compensatory leave affected the total time available, and participants described time conflicts between VHHM and emergency services; moreover, it was perceived as challenging to find sufficient time for capacity development in several different species for veterinarians working in mixed practice. The slow development toward more proactive approaches for cattle veterinarians can be explained by the numerous different factors that together constrain the veterinarian to the traditional role of diagnosing and treating sick animals. [ABSTRACT FROM AUTHOR]

Contents The aim of this field study was to evaluate the effect of supplemental feeding with glycerol (GLY) or propylene glycol (PG) during early lactation on the fertility of Swedish dairy cows. Within 17 commercial dairy herds, 798 cows were randomized to three groups that were daily fed supplements with 450 g GLY, 300 g PG or nothing (control, C). The supplements were given twice daily during 0-21 days in milk as a top dress on concentrates. Data on calving date, insemination dates, gynaecological examinations, as well as breed, parity and monthly milk yield were collected. From a subset of 308 cows in seven herds, milk samples for progesterone analysis were taken twice weekly and used to determine the time for onset of luteal activity. The effects of supplements on the intervals from calving to first luteal activity (FLA), first AI (FAI) and conception (CON), respectively, were analysed using semi-parametric survival models (Cox proportional hazards models) controlling for the effect of parity, breed, calving season, milk yield and the clustering effect of herd. There was no difference in time to FLA between the cows in group C and in group GLY or PG. No differences in time to FAI or in time to CON were found between cows in group PG and group C. However, cows in the GLY group tended to get their FAI later compared with cows in the control group but without at subsequent delaying of time to CON. [ABSTRACT FROM AUTHOR]

Contents Sustained reproductive performance throughout the life of domestic animals can be suspected to require successful rearing of replacements. We studied associations between replacement heifer rearing conditions and reproductive performance throughout the productive life of dairy cows in southwest Sweden by linear mixed modelling. Data consisted of 3542 lactations in 1550 Swedish Reds, Swedish Holsteins or dairy cows of other or mixed breeds, representing all female animals born during 1998 in 107 herds. Median calving interval (CI) was 381, 380 and 377 days in parities 1, 2 and ≥3, respectively. Median observed productive lifetime was 27 months. The applied model included effects of cow housing system, breed, parity, respiratory disease before 3 months of age, whether oestrous detection was performed only at feeding, oestrous-detection ability, calving year, post-calving reproductive disease in a given lactation, milk yield 30 days post-calving relative to the herd mean, the interaction of breed by calfhood respiratory disease and random effects of cow and herd. Severe respiratory disease before 3 months of age in Swedish Red cows was associated with an increase in CI by 12%. Of the total variation in CI, 9.5% was due to herd factors and 12% to cow factors, as opposed to variation between lactations. [ABSTRACT FROM AUTHOR]

Relationships between heifer rearing conditions and the risk of veterinary-reported clinical mastitis (VRCM) during productive life were studied by generalized linear mixed modeling at the lactation level. Data consisted of 5,693 lactations in 2,126 Swedish Reds, Swedish Holsteins, or dairy cows of other or mixed breeds, representing all female animals born in 110 herds in southwest Sweden in 1998. During a lactation, a cow was defined as affected by VRCM if one or more cases were reported by a veterinarian, starting from 7 d precalving. The applied model of VRCM included effects of breed, parity, diarrhea between 3 and 7 mo of age, increase in body weight from weaning to first breeding, increase in daily concentrate ration before first calving, herd-level median age at first calving, cow housing, and random effects of cow and herd. The VRCM incidence was 14% in a given lactation, or 0.11 cases/cow annually; 31% of the cows had VRCM at least once during their productive life. Ninety percent of the variation in mastitis risk was due to factors at the lactation level such as parity, milk yield, cow diseases, and other disturbances, instead of cow or herd factors. Severe diarrhea between 3 and 7 mo of age was associated with 2.8-fold higher odds of VRCM compared with mild diarrhea during the same period, whereas the VRCM odds of calves with mild diarrhea were half that without diarrhea. The odds of VRCM had a predicted maximum at an estimated prepubertal growth rate of 859 g/d and increased with 10% for every 1-kg increase in concentrate ration during the last 2 mo before first calving. Costs of VRCM were estimated based on assumptions regarding veterinary service, extra labor, culling and herd replacement, discarded milk, and production loss depending on parity and lactation stage when VRCM was diagnosed. The total mean costs of VRCM were estimated to be $735 per lactation with a diagnosis of CM, $103 per lactation across all cows, or $95 per cow annually during lifetime. [ABSTRACT FROM AUTHOR]

Information regarding health, management, and housing from birth to first calving was collected for 1,029 Swedish Reds, 991 Swedish Holsteins, and 40 heifers of crossbreed or other breeds on bimonthly farm visits made by 3 project veterinarians to 107 dairy herds in southwest Sweden. Additional data were obtained from the official milk- and health-recording program. Milk production at first test day after calving [energy-corrected milk (ECM)1] and during the first 305 d of lactation (ECM305), respectively, were analyzed by 2-level (animal; herd) linear regression, after initial screening by univariable analyses of 67 potentially important predictors. The ECM1 ranged from 7.9 to 48.0 (median = 27.1) kg, and ECM305 ranged from 3,764 to 12,136 (median = 8,006) kg. In the final models, factors associated with ECM1 or ECM305 or both were age at first calving, body condition score at first service, breed, calfhood diarrhea, calving season, composite somatic cell count at first test day, daily weight gain from weaning to first service, housing system after calving, and increase in concentrate fed around calving. Higher age at calving was associated with higher production. Production also increased with higher daily weight gains from weaning to first service. Swedish Holsteins produced more than Swedish Reds, cows calving in May to September produced more than those calving during other months, and cows housed in short stalls after calving produced more than those in cubicles. Body condition scores ≥3.2 at first service were associated with lower ECM305 than scores ≤2.9. Animals that contracted mild diarrhea during their first 3 mo of life had lower ECM305 than animals without diarrhea, whereas animals receiving a high increase in concentrate pre- and postcalving had higher ECM305 than those subjected to a more moderate increase. Cows with a composite somatic cell count >1 million cells/milliliter at first test day produced less milk on the same day than cows with lower counts. It was concluded that rearing factors and calfhood health status can influence first lactation milk production. [ABSTRACT FROM AUTHOR]

The serum concentration of haptoglobin (S-Hp) was measured in 833 group-housed dairy calves from nine herds in south-west Sweden once at 24-56 days of age to evaluate the potential of S-Hp as an indicator of clinical respiratory-tract disease (CRD). Presence of disease (treated and non-treated) was assessed clinically by farmers and by a project veterinarian visiting the farms every third week. The median S-Hp of healthy calves was 0.06 g/L (80% central range: 0.04-0.23), of calves with diarrhoea within the 10 days before sampling 0.07 g/L (80% central range: 0.04-0.63), and of calves with CRD within the 14 days before sampling 0.09 g/L (80% central range: 0.04-0.69). Eight different cut-off values were used to define a positive S-Hp analysis result: >0.05, >0.06, >0.07, >0.08, >0.09, >0.10, >0.15 and >0.20 g/L. A rectal temperature >39.5 °C was denoted as fever. A positive result of five different diagnostic tests for CRD was defined as: (1) a positive S-Hp with fever absent, (2) a positive S-Hp with fever present, (3) either a positive S-Hp or fever, (4) both a positive S-Hp and fever, and (5) fever (regardless of S-Hp). The sensitivity (Se) and specificity (Sp) of each test were calculated from regression coefficients of generalized linear mixed models of the binary test results, applying a logit link. Apart from CRD status (within the 14 days before sampling; no or yes), the models included sex (bull or heifer), and for the test based on S-Hp alone, also rectal temperature (fever, no or yes). Confidence intervals (CI) of Se and Sp were estimated by simulation. Based on Se, Sp, and areas under Receiver Operating Characteristics curves, test 3 was considered the best. At optimal performance, giving equal importance to type I and II errors, i.e. at a S-Hp cut-off of 0.15 g/L in heifer calves, Se was 0.64 (95% CI 0.50-0.77) and Sp 0.71 (95% CI 0.60-0.80), and at a S-Hp cut-off of 0.08 g/L in bulls, Se was 0.52 (95% CI 0.40-0.64) and Sp 0.80 (95% CI 0.74-0.85). The other tests were judged as unsatisfactory indicators of CRD. In heifers, the proportion of CRD-positive calves in the herd was strongly associated with the proportion of test positives (S-Hp or fever; S-HP and fever), suggesting potential as a herd-level indicator. [ABSTRACT FROM AUTHOR]

The mortality of 8,964 heifer calves born in 122 dairy herds in southwest Sweden in 1998 to 2000 was monitored from January. 1998 until December 2000. Farmers were requested to send carcasses for necropsy from animals that died from 1 d of age to first calving. Age and seasonal patterns of mortality were investigated using Kaplan-Meier curves. The median herd-level mortality risk was 2.1%. In total, 3.1% of the animals died before 90 d of age, 0.9% between d 91 and 210, and 2.2% between d 211 and first calving or d 810 (27 mo of age). The median age at death was 50 d and the risk of dying was highest during the first week of life. Of the 421 dead animals, 236 (56%)were subjected to either postmortem examination or were diagnosed as having died from trauma based on information from the farmers. In total, pneumonia was the most common cause of death (27%). However, in calves less than 31 d old, enteritis was the most common cause of death; in young stock 211 to 450 d old, trauma dominated; and in young stock more than 450 d old, trauma and calving-related diseases accounted for a majority of the mortality. The largest proportion of deaths was observed from January to March, and in June. Kaplan-Meier curves suggested that housing in small-group pens was associated with the lowest mortality (other housing systems were single pens and large-group pens with automatic milk feeders), but the association was not significant. [ABSTRACT FROM AUTHOR]

The dynamics of bovine respiratory syncytial virus (BRSV), bovine parainfluenza virus 3 (PIV-3), bovine corona virus (BCoV) and bovine viral diarrhoea virus (BVDV) infections were studied in 118 dairy herds in south western Sweden. By using serology on paired samples from three ∼7 vs. ∼15-month-old calves per herd, the propagation of infections was investigated over about a 1-year period. The results implied that at least 74% of calves had experienced one or more of the monitored infections at the age of ∼7 months (Sample 1, Spring); 30%, 48%, 34% and 8% were seropositive to BRSV, PIV-3, BCoV and BVDV, respectively. Seroconversions to BRSV, PIV-3, BCoV and BVDV occurred in 26%, 38%, 50% and 3% of seronegative animals and 63% had antibodies against two or more infections at ∼15 months (Sample 2). In total, 90-97%, of animals that were seropositive in Sample 1 remained positive in Sample 2. A significant association was found between BVDV and BCoV (P = 0.01). Moreover, a significantly higher proportion of herds in which no calves had a recorded history of respiratory disease (n = 15) were classified as negative to all four infections monitored when compared to herds in which disease was observed (P = 0.0002). This study showed a high infection burden in young animals and effective spread of BRSV, PIV-3 and BCoV in one area of Sweden. BVDV infections were restricted to a few herds, reflecting the effect of a voluntary control program against BVDV in Sweden. [ABSTRACT FROM AUTHOR]

Data on health, management, and housing from birth to first calving were collected for 2,126 heifers on semimonthly visits made by project veterinarians to 107 dairy herds from southwest Sweden. Additional data were obtained from the official milk- and health-recording program. Factors associated with incidence of veterinarian-treated clinical mastitis (VTCM) in the period 7 d before (d -7) to 30 d after first calving and of elevated cow composite somatic cell count (SCC, ≥200,000 cells/mL) at first test milking after first calving, respectively, were investigated using a 2-level (animal and herd) logistic regression analysis after initial screening by univariate analyses. The incidence risk of VTCM during the complete first lactation (305 d) was 10.8%. Ten percent of the diseased animals had more than 1 case of VTCM and 51% of total cases occurred from -7 to 30 d postcalving. The incidence rate of VTCM during the complete first 305-d lactation was 1.13 cases per 100 cow-mo. In total, 18.1% of the animals had elevated SCC at first test milking (mean 21 d) after calving. Veterinarian-treated clinical mastitis at -7 to 30 d postcalving was associated with higher overall incidence of mastitis in the herd and with reproductive disorders (i.e., retained placenta, endometritis, pyometra, dystocia, or twin birth). The risk of elevated SCC increased with increasing percentage of cows in the herd that, some time during the year, had had an increased udder disease score (chronically increased SCC). Other factors associated with increased risk of elevated SCC were increasing amounts of concentrates fed to 11- to 16-mo-old heifers, moving to confined housing the day of calving instead of earlier, and use of restraint measures at milking. In addition, growth rate from birth to weaning, and several feed-related variables (e.g., amount of concentrates and type of roughage given) were associated with VTCM at -7 to 30 d post calving or elevated SCC at first test milking in the univariate analyses. [ABSTRACT FROM AUTHOR]

Abstract: The health status of 2947 heifer calves born in 1998 and raised in 122 Swedish dairy herds was monitored from birth to 210 days of age. Disease occurrence was recorded by farmers and by veterinarians who visited the farms six times yearly, examined the calves clinically and auscultated their lungs. The incidence risks of diarrhoea, ringworm and clinical respiratory-tract disease (CRTD) in calves from 3 to 7 months of age were 2.7%, 5.6% and 5.7%, respectively. The herd-level incidence risks of the three diseases were zero in 63.1%, 76.2% and 48.4%, respectively, of the herds. In positive herds incidence risks were 2.2–46.4%, 2.6–47.0% and 2.2–53.3%, respectively. The associations between the potential risk factors age at first grazing, air quality, birth place, feeding of colostrum, hygiene, number of animals, age range within the pen or building, pen area, pen location, previous housing type, present housing type, previous disease and season, and each of three binary outcome variables (diarrhoea, increased respiratory sounds and CRTD) were evaluated using two-level (calf; herd) variance component logistic models. Predictors significantly associated (P <0.05) with diarrhoea were pen area, season and the interaction between pen location and previous CRTD. Previous CRTD, season and heart girth at weaning were significantly associated with moderately to severely increased respiratory sounds. Predictors significantly associated with CRTD were previous diarrhoea, previous housing and season. It was concluded that the incidence of diarrhoea and CRTD in 91–210-day-old Swedish dairy calves is higher than previously reported from dairy herds in Sweden and the USA, and that diarrhoea, increased respiratory sounds and CRTD are associated with season, a history of disease during the first 90 days of age and, to some extent, housing factors. [Copyright &y& Elsevier]

Abstract: Group pens equipped with automatic milk-feeding systems are increasingly being used for young dairy calves in Sweden. The system is, however, associated with an increased risk of clinical respiratory-tract disease and a reduced growth rate. In an experimental study we compared the health and growth rate of two different group sizes of calves (6–9 versus 12–18) kept in pens with automatic milk-feeders. The experiment was performed from September 2002 to February 2004, in nine commercial dairy farms in south-west Sweden. Each farm was equipped with two pens with automatic milk-feeders and no possibility of direct contact between calves from different pens. The calves were housed individually until 3–35 (median, 12) days of age, and then were allocated to one of the two group pens by random-number lists. Altogether 892 calves were studied: 297 in the small- and 595 in the large-sized groups. The calves’ heart girths were measured at birth and at 56 days of age. Blood samples for analysis of serum haptoglobin concentration (S-Hp) were collected once for each calf, at four to eight weeks of age. Diseases were recorded by the farmers and by a veterinarian, who visited the farms every third week and physically examined all the calves. The effects of group size on the risks of diarrhoea, clinical respiratory-tract disease and increased respiratory sounds, and on the growth rate and S-Hp were evaluated using multiple logistic- and linear-regression models with herd as fixed effect. Age at transfer to group pen, breed, immunoglobulin concentration of colostrum received, parity of the dam and presence of diarrhoea before transfer to the group pen, season, sex, year, and, in the analysis of growth rate, birth heart girth were extra explanatory variables. Calves in pens for 12–18 calves had a higher incidence of respiratory illness (OR: 1.4) and grew 0.022cm/day less than calves housed in groups of 6–9 animals (equivalent to approximately 40g/day). We detected no differences between calves kept in the small-sized versus the large-sized groups in terms of risk of diarrhoea or mean S-Hp. We concluded that housing calves in groups of under 10 calves is preferable from a health and growth perspective. [Copyright &y& Elsevier]

This study is based on a total cohort ( N = 192) of people born in 1902 and 1903 and living in southern Sweden. Subjects were assessed at baseline when 67 years of age and on eight further occasions over 34 years or until death. The participation rate in the nine examinations ranged from 78–100%. Interviews, psychological tests, and medical examinations were used as well as information on medical diagnoses from primary health care records and hospital records. The cumulative probability for the development of clinical depression during the follow-up was 8% and for anxiety 6%. The incidence rate for depression and for anxiety was highest during the period 67–81 years. Persons with poor financial status were more likely to be diagnosed with depression but no significant risk factor for anxiety was found. Only 14% developed depression and anxiety during the follow-up period, females more often than men. The strongest risk factors for the development of depression were perceived economic problems. [ABSTRACT FROM AUTHOR]

Daily feed rations, their nutrient contents and live weight gains were recorded for calves and replacement heifers from birth to calving in 122 Swedish dairy herds. Preweaned calves were fed whole milk (45% of the herds), milk replacer alone or milk replacer combined with whole milk. Calf starters were the most frequently used concentrates for preweaned calves, whereas grain dominated for weaned calves and heifers. Grain was supplemented with protein concentrates until 6 months of age and at calving. Grass/clover hay was the dominant forage for preweaned calves, whereas grass/clover silage alone or in combination with hay was the most common forage for calves and replacement heifers from 6 months of age. Heifers grazed semi-natural grasslands, leys or a combination of semi-natural grasslands and leys in 33, 15 and 52% of the herds, respectively. According to Swedish recommendations, calves in a majority of the herds were fed too low concentrations of crude protein from weaning to 6 months of age and calves were fed too low a metabolizable energy content inadequate for a daily weight gain of 700 g at weaning. Median live weight gain from birth to calving was only 567 g per day. Correct feed ration formulations and strategic grazing management could be means to increase weight gain and hence to decrease rearing costs of calves and replacement heifers in Swedish dairy herds. [ABSTRACT FROM AUTHOR]

A total of 3081 heifer calves in 122 Swedish dairy herds were monitored from birth to first calving, and all their diseases and treatments were recorded. There were 1268 cases of infectious diseases, of which 335 (26&mddot;4 per cent) were treated with antimicrobial drugs. Just over 90 per cent of the treatments were given during the first 210 days of the calves’ lives, but only 61&mddot;8 per cent of the total quantity of antimicrobial drugs was consumed during this period. The most common diseases from birth until 210 days were respiratory diseases and diarrhoea; treatments for mastitis and interdigital phlegmon (foul in the foot) were more common after 420 days of age. Slightly more than 60 per cent of the treatments were given by the farmers without prior consultation with a veterinary surgeon. [ABSTRACT FROM AUTHOR]

The objective of this study conducted in 75 herds was to investigate the presence and significance of Cryptosporidium parvum and Giardia intestinalis in Swedish dairy calves in comparison with rotavirus, coronavirus and Escherichia coli K99+. The farmers were asked to collect faecal samples from each heifer calf that had diarrhoea between birth and 90 days of age, and also from a healthy calf of the same age. In total, 270 samples were collected and analysed. C. parvum, either alone or together with G. intestinalis and/or rotavirus, was detected in 16 (11%) and 6 (5%) of the samples from diarrhoeic and healthy calves, respectively. Even though a higher proportion of diarrhoeic calves shed C. parvum, the difference between the groups was not statistically significant (p=0.067), possibly due to the low number of positive samples. G. intestinalis was found in 42 (29%) of the diarrhoea samples and in 29 (23%) of the samples from healthy calves. Rotavirus and coronavirus were demonstrated in 24% and 3% of the diarrhoea samples, respectively, whereas E. coli K99+ was only found in samples from 2 healthy calves. C. parvum and G. intestinalis were found in samples from calves 7 to 84 days of age and during all seasons. The results confirm that C. parvum is present in Swedish dairy herds and might have clinical significance. G. intestinalis was the most common agent found but the importance of this parasite remains unclear. Both parasites have suggested zoonotic potential and thus warrant further attention. In addition, rotavirus is a major pathogen in neonatal enteritis in Sweden, whereas coronavirus and E. coli K99+ seem to be of less importance. [ABSTRACT FROM AUTHOR]

Background: The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres. Methods: Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension-free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow-up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor. Results: There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow-up of 36–77 months seven recurrences were found in the Shouldice group (95 per cent confidence interval (c.i.) 1·3 to 8·1) and one in the mesh group (95 per cent c.i. 0·0 to 2·0). Chronic groin pain was reported by 4·2 and 5·6 per cent in the Shouldice and Lichtenstein groups respectively. It was characterized as mild or moderate in all except two patients who had the Shouldice operation. Conclusion: Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit. [ABSTRACT FROM AUTHOR]

A questionnaire was sent to 1500 randomly selected dairy herds in Sweden, asking for general information about the herds, including routines from birth to first calving and also routines at breeding, calving and during the grazing period. Fifty-eight percent of the questionnaires were returned. The preweaned calves were kept in individual calf pens in 68% and in group housing systems in 28% of the herds. Pens with slatted floors were the main housing system for replacement heifers from weaning to breeding, and tie stalls from breeding to first calving. Whole milk was used in 44% and milk replacements in 42% of the herds. The calves received, as a median, 2.5 litres of milk per meal and 2 meals per day. The median age at weaning was 8 weeks. Age was the single most common criteria used for deciding both weaning and breeding time. The median age when the heifers were first turned out to pasture was 6 months. Prophylactic anthelmintic treatment was used by 65% of the herds. The most common diet for replacement heifers before calving was a combination of grain, hay and silage. [ABSTRACT FROM AUTHOR]

Veterinarians often give advice in a persuasive form, a style that has been shown to evoke resistance to change in clients experiencing psychological ambivalence (i.e. those who see both advantages and disadvantages to changing). With this style of communication, veterinarians run the risk of counteracting their purpose to encourage clients to follow recommendations. Motivational interviewing (MI) is a client-centered communication methodology that aims to facilitate clients' internal motivation to change. In MI, Change Talk represents clients' own statements expressing consideration of, motivation for or commitment to behavior change and has been shown to be strongly correlated with behavior change. Sustain Talk is corresponding statements related to maintaining the status quo. The aim of this exploratory study was to evaluate the potential of MI to facilitate behavior change in veterinary herd health management (VHHM) by investigating the effect of dairy cattle veterinarians' MI skills on client Change and Sustain Talk. We recorded VHHM consultancies on 170 Swedish cattle farms performed by 36 veterinarians, randomly distributed into 2 groups: MI veterinarians (n = 18) had received 6-month training in MI and control veterinarians (n = 18) had not received any training. Veterinarians' MI skills were assessed using the Motivational Interviewing Treatment Integrity coding system 4.2.1 and categorized as poor&#95;untrained, poor&#95;trained, near moderate and moderate. Client communication was coded using the Client Language Easy Rating coding system. The effect of MI skills on Change Talk, Sustain Talk and Proportion of Change Talk(Change Talk divided by the sum of Sustain Talk plus Change Talk) was investigated using cross-classified regression models with random intercepts for veterinarian and client (farm). The models also included additional explanatory variables (e.g. type of veterinarian and client's satisfaction with the consultation). The veterinarian's MI skills were associated with the client's Change Talk, but results regarding Sustain Talk or Proportion of Change Talk were inconclusive. Clients of veterinarians reaching the highest (i.e. moderate) MI skills expressed 1.5 times more Change Talk than clients of untrained veterinarians. Clients of general large animal practitioners expressed less Sustain Talk than clients of animal health veterinarians and had higher Proportion of Change Talk. Results indicate that learning to practice MI may be one means to improve adherence to veterinary recommendations and to improve efficiency in VHHM services.

Veterinary communication has evolved in the context of traditional veterinary tasks, such as diagnosing and treating sick animals, and this may encourage a directive communication style, in which the veterinarian acts as an expert, directing the client in what to do and how to do it. This type of communication style has been shown to evoke resistance to change in clients who are experiencing psychological ambivalence, a well-known aspect of farmers' herd health decisions. Veterinary herd health management (VHHM) constitutes an increasing proportion of the work of cattle veterinarians and often focuses on behavior change. The present study aimed to characterize communication styles of Swedish dairy cattle veterinarians involved in VHHM in relation to their skills in facilitating behavior change. A secondary aim was to investigate whether these skills differed among veterinarians depending on their experience in the veterinary profession or in VHHM. Audio-recorded role-play conversations (n = 123; reflecting VHHM telephone consultations) with 42 veterinarians involved in VHHM in Swedish dairy herds and audio-recorded on-farm consultations (n = 86) with 18 of those veterinarians were coded using a system developed to evaluate motivational interviewing (MI) skills. Motivational interviewing is a communication methodology aimed at facilitating clients' internal motivation to change. The MI Treatment Integrity (MITI) code identifies frequency counts of 10 verbal behaviors, and assesses 4 global variables on a Likert scale, based on 20 min of conversation. It also suggests 6 summary measurements of MI competency based on these 14 original variables. Of the 42 veterinarians, 39 also responded to a web questionnaire about their age, continuing education, and experience in the profession, in dairy herds and in VHHM. We analyzed associations between the 6 summary MITI variables from the role-play conversations and characteristics of the 39 veterinarians using logistic and linear multivariable regression models. Veterinarians in the role-play and on-farm conversations relied predominantly on giving information, questions, and persuasion in their consultation approaches. They generally did not explore the client's expectations or wishes regarding the agenda for the consultation, or acknowledge the client's right to make decisions about actions. Veterinarians gave advice without exploring the client's need for the advice or how the information was perceived. We found a significant reduction in so-called relational scores (Empathy plus Partnership) and an increase in MI-nonadherent behaviors (Persuasion plus Confront) as years of veterinary experience increased. Results showed that there is room for improvement in the communication style of veterinarians involved in VHHM. Wider literature suggests that training veterinarians in a client-centered communication methodology such as MI may increase the demand for and success of VHHM., (The Authors. Published by FASS Inc. and Elsevier 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/).)

The problem of nonadherence to advice is recognized in several professional relationships, including the veterinarian-client relationship. A better understanding of farmer perspectives may help to improve efficiency in veterinary herd health management. This study aimed to qualitatively and quantitatively describe farmers' reasons for adherence and nonadherence with veterinary recommendations regarding preventive herd health measures. We carried out structured telephone interviews about implementation of preventive measures with owners or staff of 163 dairy farms and 6 beef farms. The farms had received an advisory visit by their veterinarian (n = 36), who had documented the preventive measures they had recommended. The interviewer noted verbatim responses to reasons for implementing preventive measures fully, partially, or not at all, and we analyzed these responses thematically. We also conducted a quantitative analysis, in which we calculated descriptive statistics of the proportions of different categories of reasons stated by the farmers. Altogether, 726 preventive measures (range per farm 1 to 17; median 3; interquartile range 2 to 6) were documented. We identified 3 organizing themes related to adherence or nonadherence with veterinary advice: trust, feasibility, and priorities. Overall, the most commonly stated reasons related to trust (in the veterinarian, in the advisory process, or in individual preventive measures). The most common reasons not to follow the recommended advice were related to feasibility. Based on the results, we recommend that, to improve adherence to their advice, veterinarians pay increased attention to farmers' needs, priorities, goals, and motives, as well as to farmers' perceptions of the effectiveness of individual preventive measures. We also recommend that veterinarians need to increase their focus on recommending preventive measures that are practically feasible to implement on farms., (The Authors. Published by FASS Inc. and Elsevier 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/).)

Aim: Respiratory syncytial virus (RSV) infections are among the most common lower respiratory tract infections in infants, but few studies have determined the age-specific incidence of hospitalisation in defined populations. This study gathered Swedish data on RSV in Gothenburg and its 10 surrounding municipalities from 2004 to 2011., Methods: Information was obtained from hospital databases of all patients up to five years of age who had a discharge diagnosis of an RSV infection and had a positive antigen detection or polymerase chain reaction test., Results: A total of 1764 children fulfilled the inclusion criteria and 238 of these were preterm. The incidence under one year of age was 17.4/1000/year, and in children aged one to four years it was 0.6/1000/year. RSV patients occupied a mean of 1141 hospital beds per year: 65 were treated in the intensive care unit, 27 needed ventilator support, 19 needed continuous positive airway pressure, 408 (23%) received antibiotics, 399 (23%) received steroids, and all but four patients received a bronchodilator. All children survived., Conclusion: The incidence of RSV infections was high, medication use was high, and complications were low. Preterm infants had a higher risk, but most infants needing hospitalisation for RSV are full term and have no known risk factors., (©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

The aim of this study was to identify possible risk factors for 1-90 day calf mortality in large Swedish dairy herds. Sixty herds with a herd size of ≥160 cows were visited once between December 2005 and March 2006. Thirty herds were known to have low mortality (LM) and 30 were known high mortality herds (HM). Upon the visit, data about housing and management was collected from interviews with personnel responsible for the calves. The herd status regarding the calves' passive transfer (total protein), levels of α-tocopherol, β-carotene and retinol, and excretion of faecal pathogens (Cryptosporidium spp., Escherichia coli F5, rota and corona virus) was evaluated based on targeted sampling of high risk calf groups; in each herd, blood and faecal samples were collected from calves 1-7 and 1-14 days old, respectively. Similarly, the herd status regarding clinical respiratory disease in calves and history of respiratory virus exposure was evaluated based on lung auscultations and blood samplings of calves 60-90 days old. The median calf mortality risk (in calves 1-90 days of age) among HM herds was 9% (Range: 6-24%) and among LM herds 1% (Range: 0-2%). LM and HM herds were compared using five logistic regression models, covering potential risk factors within different areas: "Disease susceptibility", "Factors affecting the gastrointestinal tract", "Factors related to transmission of infectious disease", "Hygiene" and "Labour management". The percentage of calves, 1-7 days old, with inadequate serum concentrations of α-tocopherol and β-carotene were significantly higher in HM herds compared to LM herds and also associated with higher odds of being a HM herd (OR=1.02; p=0.023 and OR=1.05; p=0.0028, respectively). The variable "Average number of faecal pathogens in the sampled target group" was significantly associated with higher odds of being a HM herd (OR=4.65; p=0.015), with a higher average in HM herds. The percentage of calves with diarrhoea treated with antibiotics was significantly higher in HM herds and was associated with higher odds of being a HM herd (OR=1.08; p=0.021). The median age at death of calves in the age interval 1-90 days that died during a one-year period was significantly lower among HM herds (13 days) than in LM herds (24 days) (p=0.0013) The results indicate that gastrointestinal disorders may be an important cause of calf mortality in large Swedish dairy herds. Furthermore, our study provides additional indications that fat soluble vitamins might play an important role for calf health., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Background: Endoscopic procedures using electrohydraulic lithotripsy (EHL) or intraductal laser lithotripsy (ILL) are the methods of choice for managing difficult common bile duct (CBD) stones. This retrospective study examined 10 years of Swedish experience using a mother-baby endoscopic system to assist in the fragmentation of CBD stones by EHL and ILL., Methods: Between 1995 and 2006, 44 patients with a median age of 80 years underwent EHL or ILL at two Swedish centers after conventional endoscopic fragmentation of CBD stones had failed. Long-term follow-up assessment was conducted for 9 to 126 months (median, 53 months)., Results: Final stone clearance after EHL or ILL treatment with or without additional conventional endoscopic retrograde cholangiopancreatography (ERCP) was achieved for 34 (77%) of 44 patients. The results for 10 patients (23%) were defined as failures. Complete or partial stone fragmentation and definitive duct clearance were achieved in one session for 23 patients (52%). A second EHL or ILL attempt made in five cases of primary failure led to definitive stone clearance in three cases. Two patients experienced perioperative complications (stone basket impaction). Mild post-ERCP pancreatitis occurred for one patient and cholangitis for two patients. During long-term follow-up evaluation, recurrent CBD stones were found in one patient., Conclusions: Peroral endoscopic EHL or ILL, under direct cholangioscopic visualization by a mother-baby endoscopic system, is an effective treatment for difficult CBD stones. The technique can be used safely even in frail and elderly patients. However, several endoscopic attempts may be required before final stone clearance is achieved. The vast majority of patients may be expected to remain symptom free for a prolonged period.

Purpose: The purpose of this paper is to survey Swedish healthcare leaders' patient safety awareness, the priority they give to safety issues and their views on suitable safety management strategies., Design/methodology/approach: A total 623 leaders of a sample of 1,129 responded to a mail questionnaire (55 percent response rate). Descriptive statistics of the responses are presented as frequency distributions across respondent subgroups. Means were tested for similarity by a repetitive one-way ANOVA procedure. Homogeneous response groups were sought by hierarchical cluster analysis., Findings: Swedish healthcare leaders show relatively high safety awareness and how their organizations prioritize safety management. There is a marked polarization between leaders; half feel that the system works reasonably well, and that adequate funds are available to improve or maintain services. The other half thinks the system needs major change and calls for additional funding. A majority sees system errors as the main cause for adverse events; a substantial minority find human errors to be more important. Two-thirds were willing to make safety performance information on organizations and specialties public, one third was restrictive., Research Limitations/implications: Survey instruments used to explore leaders' patient safety views have not yet been rigorously tested against psychometric criteria. One hospital type was slightly over-represented and three regions somewhat under-represented in the respondent groups., Originality/value: This is the first systematic attempt to explore the views of Swedish healthcare leaders on patient safety. It provides input to a national strategy to improve patient safety.

We carried out a longitudinal study of 122 dairy herds in southwest Sweden to investigate relationships of rearing conditions and health with heifer breeding performance and to estimate the incidence of clinical diseases and survival until 1st calving. A total of 3081 animals born in 1998 (47% Swedish Red; 50% Swedish Holstein breed) were followed from birth until calving, culling or death. Information about housing, management, breeds and dates of birth, breeding and calving was obtained from farmers. Diseases were recorded by farmers and veterinarians; antibiotic treatment was used in < 25% of all cases. Median time to breeding was 17.5 months, 64% of all heifers bred by AI conceived at 1st breeding, and median time to calving was 27.6 months. Age at 1st breeding (log-transformed), conception at 1st breeding (binary), and age at 1st calving (log-transformed) were analysed with three mixed models, accounting for clustering by considering random-intercept and random-slope effects at the herd level. Around 40 potential predictors or confounders were recorded and considered for modelling. Time to breeding and calving increase greatly with the time heifers spend grazing, although up to 5 months of grazing before 1st calving appears to be more favourable than no grazing at all. The effect of grazing differs depending on the season of birth. Zero-grazed heifers calve 20% later if exposed to indoor ammonia concentrations > 10 ppm after start of breeding. There is considerable variation between herds in breeding performance, except for conception at 1st breeding-limiting the potential for improving conception by herd measures. Observed total disease incidence rate was 14 per 100 animal-years from 7 months of age to estimated conception and 4.7 per 100 animal-years from conception to calving, with great variation between herds. Infectious diseases were predominant, and diarrhoea, respiratory disease and ringworm were the most common diagnoses. Eight hundred and fifty-three heifers left the study before calving, due to herd exits (incidence risk 0.073%), selling off live (0.061%), spontaneous deaths (0.050%) or slaughter (0.092%).

A description of a new facility for X-ray absorption spectroscopy at the materials science beamline, I811, at MAX-lab synchrotron source, Lund, Sweden, is given. The beamline is based on a superconducting multipole wiggler source inserted in a straight section of the 1.5 GeV MAX-II ring. X-rays in the energy range 2.4-12 keV are extracted by a standard optical scheme consisting of a vertical collimating first mirror, double-crystal monochromator, and a second vertically focusing mirror. The second monochromator crystal provides sagittal focusing. The total flux impinging on the sample at 9 keV is 5 x 10(11) photons s(-1), for a minimum beam spot of 0.5 mm x 0.5 mm. The beamline has facilities for experiments in transmission, fluorescence and total-electron-yield mode and experiments have been performed by international research groups on a wide range of materials, such as dilute systems with metal concentrations below 10 p.p.m.

Background: Repeat prescribing used in long-term pharmacotherapy is often associated with inadequate patient medication, including non-adherence. In this paper we explore patients' drug refill adherence with repeat prescriptions and relate refill data to patient age and gender, type of prescriber, type of prescribed drug, and reimbursement level., Methods: During one week of 2002, copies of 3636 repeat prescriptions filled at 16 large Swedish pharmacies were collected. Satisfactory refill adherence was defined as dispensed refills covering 80-120% of the prescribed treatment time. Under- and oversupplying were defined as <80% and >120% coverage, respectively., Results: The average level of refill adherence was 57%, and the level of under- and oversupplying 21% and 22%, respectively. There was no gender difference. Patients who were exempt from payment had higher oversupplies than others (33% versus 19%), and patients of general practitioners had higher refill adherence than patients of hospital physicians. The highest refill adherence was observed for contraceptives (81%) and the lowest for anti-asthmatics, proton pump inhibitors and non-steroidal anti-inflammatory drugs (30-40%)., Conclusions: Refill non-adherence includes both under- and oversupplying and may vary due to different attitudes between prescribers and between patients. Different therapeutic indications and reimbursement systems are other apparent causes. These observations should be considered in programs aiming to assist patients in following medication prescriptions.

The health of 3081 heifer calves born in 122 dairy herds in the south-west of Sweden from 1 January to 31 December, 1998, was monitored from birth until 90 days of age. The calves were kept either in individual pens (n=2167), in group pens, with 3-8 calves to a pen and manual feeding of milk (n=440), in group pens with 6-30 calves per pen and an automatic milk-feeding system (n=431), or with their dams (n=43). Disease incidence was recorded by farmers and project veterinarians, who clinically examined the calves and auscultated their lungs every 2-3 months. A disease was graded as 'severe' if the general loss of condition or of appetite in the calf continued for >2 days or if the animal suffered severe weight loss due to the disease. The effects of season, breed, housing, and type of colostrum feeding, and time, place and supervision of calving on the incidences of diarrhea, severe diarrhea, respiratory disease, other infectious disease and moderately to severely increased respiratory sounds, were analyzed by logistic-regression models (with herd as a random effect). The total morbidity rate was 0.081 cases per calf-month at risk. Incidence rates of arthritis, diarrhea, omphalophlebitis, respiratory disease and ringworm were 0.002, 0.035, 0.005, 0.025 and 0.009 cases per calf-months at risk, respectively. The odds ratios for diarrhea and severe diarrhea were increased in Swedish Red and Whites (OR: 1.6, 2.3) and in calves that received colostrum from first-lactation cows (OR: 1.3-1.8), and for severe diarrhea in calves born in summer or that received colostrum through suckling (OR: 1.7, 1.8). The odds ratios for respiratory disease and increased respiratory sounds were increased in calves housed in large-group pens with an automatic milk-feeding system (OR: 2.2, 2.8). Supervision of calving was associated with a decreased odds ratio for respiratory disease (OR: 0.7) and birth in individual maternity pen or tie stalls with a decreased odds ratio for increased respiratory sounds (OR: 0.5-0.6). Cross-breeds with beef breeds were associated with increased odds ratios for increased respiratory sounds (OR: 2.1-4.3) and colostrum from second-lactation cows and birth during night for other infectious disease (OR: 1.6, 1.5).

Infections with internal parasites are one of the most important causes of reduced productivity in first-grazing season cattle (FGSC). In conventional herds, nematode infections can be controlled by prophylactic anthelmintic treatments, but this is prohibited in organic production. The purpose of this investigation was to monitor the status of internal parasitism on 15 organic cattle enterprises in southwestern Sweden during the 1997 and 1998 grazing seasons, and to estimate the benefits of some management practices in parasite control. On each farm, the numbers of Eimeria alabamensis oocysts per gram of (opg) faeces were counted in seven fresh dung pats collected from the paddock 8-10 days after the turnout of FGSC. Faecal samples from 5 to 15 FGSC were also analysed for nematode eggs per gram (epg) faeces at four occasions during each grazing season. In addition, the FGSC and one group of second-grazing season cattle (SGSC) were weighed at turnout and housing and at the same time blood samples were collected, and analysed for serum pepsinogen concentration and antibodies against the lungworm, Dictyocaulus viviparus. On seven farms, 1-6 samples with more than 100000 opg were found, indicating considerable pasture contamination by E. alabamensis. However, clinical signs of coccidiosis were not observed. The highest outputs of nematode eggs were observed 45-55 days after turnout. More than 500 epg were only observed in 12 (2.2%) of the calves in 1997 and in three (0.6%) animals in 1998. Only 1% of the serum samples had pepsinogen values exceeding 3.6 U tyrosine, indicative of subclinical Ostertagia ostertagi infection. Lungworm infection was detected in five and nine herds in 1997 and 1998, respectively. The number of seropositive animals on these farms ranged between one (10%) and seven (70%). Clinical signs of dictyocaulosis were observed on two farms. The results indicate that dictyocaulosis is a problem in organic dairy herds in Sweden. On the other hand, the study shows that good management such as usage of parasite safe pastures and supplementary feeding may help control gastrointestinal parasites.

This longitudinal study examines the relationship between family and friend social support, health, and life satisfaction for a single cohort of eighty-year-old persons living in Lund, Sweden. Results indicate that participants who remained in the study are healthier and score higher on life satisfaction when compared with those who either drop-out or die prior to age eighty-three. Even though well-integrated with family and friends, the number of friends decreases significantly from eighty to eighty-three years; those who reported no close friends nearly doubled from eighty to eighty-three years. However, for those with close friends, contact with friends increases with age. In contrast to previous research, a correlational analysis indicates that neither child nor friend support is related to life satisfaction at either eighty or eighty-three years. However, health measures and satisfaction with sibling contact are related to total life satisfaction at age eighty-three only. These findings indicate the multidimensionality of both social support and life satisfaction for the old-old.

We conducted a population-based case-control study in Stockholm during 1989-1995 to investigate the risk of lung cancer from exposure to environmental tobacco smoke. The study base consisted of persons above 30 years of age resident in Stockholm County who had never smoked regularly (that is, one cigarette or more daily for 1 year). Cases of lung cancer were identified at the three major county hospitals responsible for diagnosis and treatment of lung cancer. A total of 124 cases (35 men and 89 women) and 235 population controls (72 men and 163 women) participated. The never-smoking status was validated by interviews with next-of-kin. The relative risk associated with ever-cohabiting with a smoking spouse was 1.2 [95% confidence interval (CI) = 0.7-1.9]. Ever-exposure at work to environmental tobacco smoke carried a relative risk of 1.6 (95% CI = 0.9-2.9). Risks tended to be more elevated in high-exposure groups and with recent exposures. Both sources of environmental tobacco smoke seemed important, and considerable misclassification of total exposure occurred for each variable used separately, in particular for the less common spousal exposure. For those currently exposed to environmental tobacco smoke from the spouse, at work, or both, the relative risk was 2.6 (95% CI = 1.0-6.5). Our data imply that information from major sources of environmental tobacco smoke should be combined to avoid important misclassification and that timing of exposure should also be taken into consideration.

The Swedish National Care Programme for Anal Carcinoma (SNCPAC) was instituted in order to create a uniform handling policy for anal cancer and thus to accrue a population-based material allowing unbiased analyses. This study evaluates the degree of implementation of the SNCPAC guidelines, and presents overall treatment results in a total of 356 patients with epidermoid cancer of the anus and the perianal region diagnosed in Sweden between 1985 and 1989. Primary treatment according to the guidelines was irradiation up to 40 Gy, Bleomycin was administered intramuscularly before the first 18 fractions. After a 3-week pause, radiotherapy was to be continued up to a dose of 60-64 Gy, if at least an almost complete response was achieved. Otherwise, the patient was recommended surgery within a week. The guidelines were applied in 90%, of cases where such treatment was possible. The 5-year tumour-specific survival rate was 72%. The survival rate was more favourable in perianal tumours (90%) than in anal canal tumours (68%, p < 0.01). The 5-year probability of having a preserved anus was 64% (anal canal/perianal 58%/91%, p < 0.001). Bleomycin did not appear to have any effect on treatment results. The care programme has had a rapid and almost complete nation-wide penetration, and h as created the desired uniformity allowing proper analyses. The treatment results also appear comparable with specialised referral centres.

Six of the 33 calves born in a Swedish dairy herd during a period of four months developed laminitis when they were eight to 12 weeks old. The clinical signs included difficulty in rising, a stiff gait, overgrown claws and haemorrhages in the sole horn. Samples of blood were taken from four of the calves when they had shown signs of laminitis for two to seven weeks; the serum concentrations of calcium, phosphorus and vitamin D3, the activities of aspartate aminotransferase and glutathione peroxidase, and the patterns of serum proteins were within their normal ranges. The feet of the same four calves were examined after slaughter; the third phalanx of each calf was rotated and its distal end osteolytic. Histologically there was separation and degeneration of the squamous cells of the white line, and thromboses and vasculitis in the fine vessels of the corium. Four of the six affected calves were persistently infected with bovine viral diarrhoea virus and one had antibodies against the virus. From six weeks of age the calves had been fed rye wheat, a hybrid seed rich in starch, and this may have contributed to the outbreak of laminitis.

From a permanent pasture where young cattle had contracted coccidiosis due to Eimeria alabamensis 2 years previously, hay was harvested and fed to six 2-4 month old calves 15 days, 4 months or 8 months after being harvested. The excretion of oocysts by these exposed calves was compared with that by five control calves of similar age which were housed in the same premises but fed hay from a 'coccidia-free' field. All calves fed the contaminated hay developed patent E. alabamensis infections and excreted 142000 to 4.2 million oocysts of this species per gram of faeces starting 8 days after the hay was first fed. Five of them had soft (porridge-like to gruel-like) faeces and/or poor appetite. The control calves excreted no or very few oocysts and had firm faeces and unaffected appetite. It is concluded that making hay from pastures contaminated with oocysts of E. alabamensis is unsatisfactory if the hay is to be used for feeding young cattle.

The extent to which oocysts of the coccidian parasite Eimeria alabamensis can survive the winter and cause clinical coccidiosis in different parts of Sweden was investigated. Fecal samples were collected between May and July 1993 from calves on 59 farms where calves had grazed the same pasture for at least 5 consecutive years. The farms were situated in 9 regions of Sweden with different climatic conditions in the winter. On each farm, 5 samples of feces were collected from the floor of the calf-house before the calves were turned out in the spring, and again from the pasture on days 4 or 5, 8 or 9 and 10 or 11 after they were turned out. Overwintering of oocysts of E. alabamensis was considered to have occurred if an increase in the excretion rate of oocysts of this species could be demonstrated 8 to 11 days after calves had been turned out to pastures that had not been grazed since the previous autumn. Oocysts were shown to have overwintered on 27 farms, representing all 9 regions. Samples from 20 (34%) of the farms representing all the climatic regions contained more than 850,000 oocysts per g of feces. This was comparable with the numbers found in animals with clinical coccidiosis due to E. alabamensis. Delaying turnout until the beginning of July did not affect the infection rate of the calves. However, calves which were turned out to pastures that had been grazed by older cattle or horses, either earlier in the spring or in previous years, excreted significantly fewer oocysts than calves which were turned out to pastures that had been grazed only by calves. A questionnaire answered by 321 dairy farmers revealed that of the 298 farmers who turned their first-season grazing cattle out to traditional pastures, 179 (60%) had used the same pasture for at least 5 years. These 179 farmers had experienced a significantly higher incidence of diarrhoea in their calves during the first 2 weeks at pasture than those farmers who had used different pastures.

Large numbers of oocysts of Eimeria alabamensis have been found in the faeces of calves suffering from diarrhoea shortly after being turned out to pasture. To investigate the source and clinical significance of this coccidial infection, the numbers of oocysts excreted, the consistency of the faeces and the growth rates of four groups of 12 calves were compared. Group I calves were kept indoors and their diet was unchanged, Group II calves were turned out onto a previously ungrazed pasture, Group III calves were turned out onto a permanent pasture and Group IV calves were kept indoors and fed cut grass from a previously ungrazed field. Eight days after the animals were turned out there was an almost 1000-fold increase in the numbers of oocysts in the faeces of Group III calves, the dominant species being E. alabamensis, but there were only minor fluctuations in the numbers of oocysts excreted by the other groups. It was therefore concluded that the source of the infection was oocysts that had overwintered on the permanent pasture. Most of the calves in Group III developed watery diarrhoea 5 days after turnout, but there was only a slight softening of the faeces of the calves in Groups II and IV at about the same time. The faeces of the calves in Group I was of firm consistency throughout the trial. The calves in Group III lost 18 kg during the 24 day period following turnout, whereas the calves in the other groups gained between 6 and 18 kg.

Four groups of three conventionally reared 2-month-old bull calves were inoculated with 10 million to 400 million sporulated oocysts of Eimeria alabamensis isolated from Swedish calves which had diarrhoea while at pasture. Their appetite, clinical condition, growth rate and the dry matter content of their faeces were compared with those of three similar but uninoculated calves. The prepatent period was 6-8 days, and the period during which large numbers of oocysts were excreted was 2-7 days. In two of the inoculated calves only a slight softening of the faeces was observed. The other ten calves developed watery diarrhoea, had a poor appetite and appeared depressed. The clinical signs were most severe in the calves which received the highest doses and included signs of abdominal pain and a reluctance to rise. The growth rates of the infected calves were significantly reduced for 18 days after inoculation, and 71 days after inoculation they had not compensated for this period of reduced growth rate.

The prognostic significance of pre-treatment serum concentration of squamous cell carcinoma antigen (SCCAg) was investigated in a population of 60 patients with anal epidermoid cancer. Serum concentration was determined during the period 1985-90. The patients were followed until December 1991. An antigen level above 2.0 ng/ml was classified as elevated. Thirty-eight patients had T1-2 tumours, while 22 had T3-4 tumours. Sixteen of the 20 patients (80%) with an elevated SCCAg concentration relapsed or had residual tumour after conclusion of primary therapy, compared to 8 of 40 (20%) with a normal concentration (P = 0.00001). Six patients of 40 (15%) with a normal SCCAg had died at the end of follow-up compared to 10 of 20 (50%) with an elevated value (P = 0.006). For patients with T1-2 tumours 2 of 29 (7%) with a normal SCCAg had died with or from their cancer compared to 3 of 9 (33%) with an elevated value (P = 0.14); for T3-4 tumours these figures were 3 of 11 (P = 0.14); for T3-4 tumours these figures were 3 of 11 (27%) and 7 of 11 (64%) respectively (P = 0.009). Actuarial survival analyses for patients with normal vs elevated SCCAg concentration showed that the projected five year overall survival was 81% for those with a normal level and 43% for those with an elevated level (P = 0.004). For tumour specific survival the figures were 83% vs 45% (P = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

Faecal samples were collected 3 times a week for 6 weeks from 22 paripartal cows and for up to 15 weeks after birth from 27 calves in 3 herds, to determine the numbers of Eimeria oocysts excreted and the age at which the calves first excreted oocysts. Only low numbers of oocysts were excreted by the cows and no oocysts were detected in 93% of the samples. However, half the cows excreted oocysts at least once. The age at which the calves first excreted oocysts ranged from 2.5 to at least 15 weeks, and there was a significant difference between the herds in their mean age at first excretion. Oocysts of Eimeria alabamensis, E. auburnensis, E. bovis and E. ellipsoidalis were found in numbers ranging from 7 to 8450 oocysts per gram faeces. About 50% of the calves excreted oocysts before they were transferred to group pens. The primary source of infection of the calves was probably their penmates or the previous occupants of the pens, and the cows probably played a subsidiary role.

The numbers of Eimeria oocysts per gram (opg) and the dry matter content of 449 faecal samples taken from 54 calves in 8 herds in south west Sweden were determined during the last 2 weeks before and the first 3 weeks after the animals were turned out to pasture. While they were housed only between 0 and 580 opg were found and in 2 of the herds the numbers of oocysts remained low after turn-out. In the other 6 herds the numbers of oocysts increased after 8 to 10 days and reached a peak of between 1080 and 80,803 opg 9 to 18 days after turn-out. By 21 to 24 days after turn-out the opg-values had declined to their initial levels. Eimeria alabamensis accounted for most of the increase, but small numbers of oocysts of E. auburnensis, E. bovis, E. bukidnonensis, E. cylindrica, E. ellipsoidalis, E. pellita, E. subspherica, E. wyomingensis and E. zuernii were also observed. The interval between turn-out and the start of the increase in excretion of oocysts corresponded closely to the prepatent period of E. alabamensis and overwintered oocysts were therefore the most likely source of the infection. In 6 of the herds the dry matter content of the faeces of the calves decreased after turn-out and 56% of the calves had clinical diarrhoea. Although it cannot be excluded that change of diet may have contributed to these symptoms, E. alabamensis infection is suggested as a potential cause of diarrhoea and loss of condition in calves in Sweden during their first weeks on pasture.

A case-control study was undertaken to investigate the role of residential radon exposure for lung cancer. The study included 210 women with lung cancer diagnosed from 1983-1986 in the county of Stockholm and 191 hospital and 209 population controls. Interviews provided information on lifetime residences and smoking. Radon concentrations measured in 1,573 residences of the study subjects showed a lognormal distribution with arithmetic and geometric means of 127.7 and 96.0 Bq m-3, respectively. Lung cancer risks tended to increase with estimated radon exposure, reaching a relative risk of 1.7 (95% confidence interval: 1.0-2.9) in women having an average radon level exceeding 150 Bq m-3 (4 pCi L-1). Stronger associations were suggested in younger persons and risk estimates appeared to be within the same range as those projected for miners. However, further studies are needed to clarify the level of risk associated with exposure to residential radon.

The relation between passive smoking and lung cancer was examined by means of a case-control study in a cohort of 27,409 nonsmoking Swedish women identified from questionnaires mailed in 1961 and 1963. A total of 77 cases of primary carcinoma of the bronchus or lung were found in a follow-up of the cohort through 1980. A new questionnaire in 1984 provided information on smoking by study subjects and their spouses as well as on potential confounding factors. The study revealed a relative risk of 3.3, constituting a statistically significant increase (p less than 0.05) for squamous cell and small cell carcinomas in women married to smokers and a positive dose-response relation. No consistent effect could be seen for other histologic types, indicating that passive smoking is related primarily to those forms of lung cancer which show the highest relative risks in smokers.

A case-referent study on the possible association between radon emanating from the ground and bronchial cancer was carried out on 292 female lung cancer cases and 584 matched population referents. Both groups had lived for at least 30 years in the city of Stockholm, Sweden. The cases were diagnosed during 1972 to 1980 with oat-cell and other types of anaplastic pulmonary carcinomas. A sample of about 10% of the dwellings where cases and referents had lived was selected for measurements of radon and radon daughters. There was a relative risk of 2.2 (P = 0.01) for lung cancer associated with living in dwellings close to the ground in areas with an increased risk of radon emanation. Smoking habits did not appear to be a major confounding factor for this association, although a detailed evaluation was not possible. The measurements indicated increased radon daughter concentrations in ground level dwellings within radon risk areas where lung cancer cases had lived, suggesting that this exposure was of etiologic importance.