Validation of a single item to assess daytime sleepiness for the Swiss Transplant Cohort Study

Context-Daytime sleepiness in kidney transplant recipients has emerged as a potential predictor of impaired adherence to the immunosuppressive medication regimen. Thus there is a need to assess daytime sleepiness in clinical practice and transplant registries.Objective-To evaluate the validity of a single-item measure of daytime sleepiness integrated in the Swiss Transplant Cohort Study (STCS), using the American Educational Research Association framework.Methods-Using a cross-sectional design, we enrolled a convenience sample of 926 home-dwelling kidney transplant recipients (median age, 59.69 years; 25%-75% quartile [Q25-Q75], 50.27-59.69), 63% men; median time since transplant 9.42 years (Q25-Q75, 4.93-15.85). Daytime sleepiness was assessed by using a single item from the STCS and the 8 items of the validated Epworth Sleepiness Scale. Receiver operating characteristic curve analysis was used to determine the cutoff for the STCS daytime sleepiness item against the Epworth Sleepiness Scale score.Results-Based on the receiver operating characteristic curve analysis, a score greater than 4 on the STCS daytime sleepiness item is recommended to detect daytime sleepiness. Content validity was high as all expert reviews were unanimous. Concurrent validity was moderate (Spearman ϱ, 0.531; P< .001) and convergent validity with depression and poor sleep quality although low, was significant (ϱ, 0.235; P<.001 and ϱ, 0.318, P=.002, respectively). For the group difference validity: kidney transplant recipients with moderate, severe, and extremely severe depressive symptom scores had 3.4, 4.3, and 5.9 times higher odds of having daytime sleepiness, respectively, as compared with recipients without depressive symptoms.Conclusion-The accumulated evidence provided evidence for the validity of the STCS daytime sleepiness item as a simple screening scale for daytime sleepiness.

[Castration of calves: a survey among Swiss suckler beef farmers]

In fall 2004, a survey of a representative sample of 1185 Swiss suckler beef farmers was carried out by questionnaire (return rate 51.9%). 32.7% of the respondents castrated their calves without the help of a veterinarian, 37.8% mandated a veterinarian to carry out the castrations and 29.4% did not castrate their bull calves at all. On average, 8 calves were castrated per farm and year at an average age of 7 days when the castration was carried out by a farmer or 34 days when the castration was carried out by a veterinarian. Almost all farmers castrated their calves with the rubber ring, and a majority considered no other method as feasible. 73.9% of the veterinarians used the Burdizzo technique, 14.9% applied rubber rings, and 11.2% performed a surgical procedure. 22.6% of the farmers and 85.4% of the veterinarians used sedation; local anaesthesia was performed in 32.1% of the castrations carried out by farmers and in 84.5% of the castrations carried out by veterinarians. 65.7% of the farmers were concerned by the change of the Swiss Animal Protection Ordinance (2001), when pain relief became mandatory. 47.6% of these farmers changed their castration routine: 53.1% now mandated a veterinarian, 33.0% used sedation or local anaesthesia and 8.9% abandoned castration of their calves. 59.8% of the farmers intended to participate in a future course for laymen, to study and train the technique of local anaesthesia for castration. Castration of their calves is for many suckler beef farmers an inevitable husbandry procedure. The political goal, that all calves shall be castrated with local anaesthesia can only be reached when livestock owners are informed about the distress caused by the castration and convinced of the benefit of the local anaesthesia.Veterinarians are important information carriers in this process. The implementation also produces work, be it the more complex castration procedure or the education of the farmers who want to carry out the local anaesthesia themselves.

[Hyena disease in a Brown Swiss heifer]

A heifer with developmental skeletal disorder was presented to the ruminant clinic of the University of Berne. Abnormal long bone growth and a wobbling gait were the main clinical signs. All long bones were examined radiologically, several parameters of body size were measured and the results were compared to the measurements of a healthy control animal. Haematology and blood chemistry were normal. Based on the poor prognosis the animal was slaughtered. The final diagnosis of hyena disease was based on the characteristic growth disturbances in the caudal parts of the body, giving the animal a hyena-like appearance. For the first time a case of hyena disease is reported in Switzerland.

Management, feeding, production, reproduction and udder health on organic and conventional Swiss dairy farms

Organic dairy farms (OP; n=60) and conventional dairy farms (integrated production, IP; n=60), matched in size, location, and agricultural zone (altitude), were studied for possible differences in management, feeding, production, reproduction and udder health. OP and IP farms were similar in size (17.7 and 16.9 ha), milk quota (65900 and 70,000 kg/year), cow number (14 and 15), cow age (5.3 and 5.2 years), housing of cows of the Simmental x Red Holstein or Holstein breeds (87 and 75%; 45 and 60%), but differed significantly with respect to loose housing systems (18 and 7%), outside paddocks (98 and 75%), energy-corrected 305-d milk yield (5,695 and 6,059 kg), milk protein content (31.8 and 32.7 g/kg), use of bucket milking systems (73 and 33%), observance of regular (12-h) milking intervals (47 and 68%), routine application of the California-Mastitis-Test (10 and 28%), teat dipping after milking (25 and 43%) and blanket dry cow treatments (0 and 45%). Milk somatic cell counts on OP and IP farms (119 000 and 117,000/mL) and reproduction data were similar and there were no significant differences between OP and IP farms as concerns available feeds, planning and management of feeding. Alternative veterinary treatments were used more often on OP than IP farms (55 and 17%). Main causes for cow replacements on OP and IP farms were fertility disorders (both 45%), age (40 and 42%), sale (30 and 37%) and udder health (35 and 13%).Between OP and IP Swiss dairy farms thus relatively few larger differences were found.

Coprological study on intestinal helminths in Swiss dogs: temporal aspects of anthelminthic treatment

Coproscopic examination of 505 dogs originating from the western or central part of Switzerland revealed the presence (prevalence data) of the following helminthes: Toxocara canis (7.1%), hookworms (6.9%), Trichuris vulpis (5.5%), Toxascaris leonina (1.3%), Taeniidae (1.3%), Capillaria spp. (0.8%), and Diphyllobothrium latum (0.4%). Potential risk factors for infection were identified by a questionnaire: dogs from rural areas significantly more often had hookworms and taeniid eggs in their feces when compared to urban family dogs. Access to small rodents, offal, and carrion was identified as risk factor for hookworm and Taeniidae, while feeding of fresh and uncooked meat did not result in higher prevalences for these helminths. A group of 111 dogs was treated every 3 months with a combined medication of pyrantel embonate, praziquantel, and febantel, and fecal samples were collected for coproscopy in monthly intervals. Despite treatment, the yearly incidence of T. canis was 32%, while hookworms, T. vulpis, Capillaria spp., and Taeniidae reached incidences ranging from 11 to 22%. Fifty-seven percent of the 111 dogs had helminth eggs in their feces at least once during the 1-year study period. This finding implicates that an infection risk with potential zoonotic pathogens cannot be ruled out for the dog owner despite regular deworming four times a year.

Simulating the impact of four control strategies on the population dynamics of Neospora caninum infection in Swiss dairy cattle

A dynamic deterministic simulation model was developed to assess the impact of different putative control strategies on the seroprevalence of Neospora caninum in female Swiss dairy cattle. The model structure comprised compartments of "susceptible" and "infected" animals (SI-model) and the cattle population was divided into 12 age classes. A reference model (Model 1) was developed to simulate the current (status quo) situation (present seroprevalence in Switzerland 12%), taking into account available demographic and seroprevalence data of Switzerland. Model 1 was modified to represent four putative control strategies: testing and culling of seropositive animals (Model 2), discontinued breeding with offspring from seropositive cows (Model 3), chemotherapeutic treatment of calves from seropositive cows (Model 4), and vaccination of susceptible and infected animals (Model 5). Models 2-4 considered different sub-scenarios with regard to the frequency of diagnostic testing. Multivariable Monte Carlo sensitivity analysis was used to assess the impact of uncertainty in input parameters. A policy of annual testing and culling of all seropositive cattle in the population reduced the seroprevalence effectively and rapidly from 12% to <1% in the first year of simulation. The control strategies with discontinued breeding with offspring from all seropositive cows, chemotherapy of calves and vaccination of all cattle reduced the prevalence more slowly than culling but were still very effective (reduction of prevalence below 2% within 11, 23 and 3 years of simulation, respectively). However, sensitivity analyses revealed that the effectiveness of these strategies depended strongly on the quality of the input parameters used, such as the horizontal and vertical transmission factors, the sensitivity of the diagnostic test and the efficacy of medication and vaccination. Finally, all models confirmed that it was not possible to completely eradicate N. caninum as long as the horizontal transmission process was not interrupted.

Incidence of Neospora caninum and other intestinal protozoan parasites in populations of Swiss dogs

The protozoan parasite Neospora caninum is one of the most important abortifacient organisms in cattle worldwide. The dog is known to act as definitive host although its potential role as infection source for bovines still remains unelucidated. The aim of the present study was to compile initial epidemiological data on the prevalence and incidence of N. caninum in Swiss dogs acting as definitive hosts. Thus, 249 Swiss dogs were investigated coproscopically in monthly intervals over a period of 1 year. A total of 3289 fecal samples was tested by the flotation technique. Among these, 202 were shown to contain Sarcocystis sp. (6.1%), 149 Cystoisospora sp. (=Isospora sp.; 4.5%) and 25 Hammondia/Neospora-like oocysts (HNlO) (0.7%). All but one sample containing HNlO were from different dogs; one dog shed HNlO at two subsequent time points. Calculation of the yearly incidence for HNlO resulted in the surprisingly high value of 9.2%. Farm dogs exhibited a higher incidence for HNlO than urban family dogs. Thirteen out of the 25 HNlO-samples showed sporulation after 5 days incubation at room temperature. HNlO were further differentiated by species-specific PCR. However, all HNlO-samples were negative for N. caninum, Hammondia heydorni and Toxoplasma gondii. One reason may be the low oocyst density found in most fecal samples, which did not permit us to carry out PCR under optimal conditions. Three out of the 25 HNlO-cases contained enough oocysts to allow further enrichment and purification by the flotation technique. Subsequently, twenty to fifty sporulated HNlO-oocysts were orally administered to Meriones unguiculatus. All gerbils were seronegative for N. caninum at 5 weeks p.i. A N. caninum-seroprevalence of 7.8% was determined by ELISA upon 1132 serum samples collected from dogs randomly selected by veterinarians among their clinical patients.

[Histiocytic sarcoma in the Swiss population of Bernese mountain dogs: a retrospective study of its genetic predisposition]

A retrospective study to evaluate the genetic predisposition for histiocytic sarcoma in the Swiss population of purebred Bernese mountain dogs identified 51 histologically confirmed cases between 1997 and 2003. Segregation analysis using five major genetic modes was used to evaluate the 51 cases. The general mode yielded the best results suggesting a genetic predisposition for histiocystic sarcoma in this breed. The disease was found in all families analyzed, therefore elimination of the disease through seletive breeding of certain family lines is not possible.

Assessment of estrogenic exposure in brown trout (Salmo trutta) in a Swiss midland river: integrated analysis of passive samplers, wild and caged fish, and vitellogenin mRNA and protein

This field study examined the vitellogenin (VTG) biomarker response under conditions of low and fluctuating activities of environmental estrogenicity. The present study was performed on immature brown trout (Salmo trutta) exposed to the small river Luetzelmurg, which is located in the prealpine Swiss midland region and receives effluents from a single sewage treatment plant (STP). To understand better factors influencing the relationship between estrogenic exposure and VTG induction, we compared VTG levels in caged (stationary) and feral (free-ranging) fish, VTG levels in fish from up- and downstream of the STP, and two different methods for quantifying VTG (enzyme-linked immunosorbent assay vs real-time reverse transcription-polymerase chain reaction), and we used passive samplers (polar organic chemical integrative sampler [POCIS]) to integrate the variable, bioaccumulative estrogenic load in the river water over time. The POCIS from the downstream site contained approximately 20-fold higher levels of bioassay-derived estrogen equivalents than the POCIS from the upstream site. In feral fish, this site difference in estrogenic exposure was reflected in VTG protein levels but not in VTG mRNA. In contrast, in caged fish, the site difference was evident only for VTG mRNA but not for VTG protein. Thus, the outcome of VTG biomarker measurements varied with the analytical detection method (protein vs mRNA) and with the exposure modus (caged vs feral). Our findings suggest that for environmental situations with low and variable estrogenic contamination, a multiple-assessment approach may be necessary for the assessment of estrogenic exposure in fish.

Prevalence of risk factors for cardiovascular disease in HIV-infected patients over time: the Swiss HIV Cohort Study

OBJECTIVE: Metabolic changes caused by antiretroviral therapy (ART) may increase the risk of coronary heart disease (CHD). We evaluated changes in the prevalence of cardiovascular risk factors (CVRFs) and 10-year risk of CHD in a large cohort of HIV-infected individuals. METHODS: All individuals from the Swiss HIV Cohort Study (SHCS) who completed at least one CVRF questionnaire and for whom laboratory data were available for the period February 2000 to February 2006 were included in the analysis. The presence of a risk factor was determined using cut-offs based on the guidelines of the National Cholesterol Education Program (NCEP ATP III), the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), the American Diabetes Association, and the Swiss Society for Cardiology. RESULTS: Overall, 8,033 individuals completed at least one CVRF questionnaire. The most common CVRFs in the first completed questionnaire were smoking (57.0%), low high-density lipoprotein (HDL) cholesterol (37.2%), high triglycerides (35.7%), and high blood pressure (26.1%). In total, 2.7 and 13.8% of patients were categorized as being at high (>20%) and moderate (10-20%) 10-year risk for CHD, respectively. Over 6 years the percentage of smokers decreased from 61.4 to 47.6% and the percentage of individuals with total cholesterol >6.2 mmol/L decreased from 21.1 to 12.3%. The prevalence of CVRFs and CHD risk was higher in patients currently on ART than in either pretreated or ART-naive patients. CONCLUSION: During the 6-year observation period, the prevalence of CVRFs remains high in the SHCS. Time trends indicate a decrease in the percentage of smokers and individuals with high cholesterol.