Age at puberty and pregnancy rate in beef heifer genotypes with contrasting nutritional intake from 8 to 13 months of age.

The aim of this study was to examine the effect of plane of nutrition between 8 and 13 months of age on reproductive performance of heifers of early (EM; n = 154) or late (LM; n = 155) maturing beef breeds and with dairy (dairy-bred, n = 154) or beef (beef-bred, n = 155) dams. Heifers were fed to have an average daily gain (ADG) of 0.50 kg (MOD) or >1.00 kg (HI) for a 141- and 150-day indoor winter period. Subsequently, heifers grazed pasture, and a 12 week breeding programme was implemented. Compared to heifers fed the MOD intake diet, heifers fed the HI intake diet were younger (P < 0.001) and had greater bodyweights (P < 0.001) at puberty but did not have a greater 6- (P =  0.41) or 12- (P =  0.32) week pregnancy rate. Dairy-bred heifers were of a similar age (P = 0.55) but had a lesser bodyweight (P <  0.001) at puberty and had a greater 6- (P <  0.05) and 12- (P < 0.01) week pregnancy rate compared to beef-bred heifers. Compared to LM heifers, EM heifers were younger (P < 0.001), had a lesser bodyweight (P < 0.01) at puberty and had a greater 6-week (P < 0.01) but not 12-week (P =  0.96) pregnancy rate. Enhanced nutrition resulted in a younger age at puberty but had no effect on 12-week pregnancy rate. Dam but not sire breed affected 12-week pregnancy rate.

Early onset of puberty in cattle: implications for gamete quality and embryo survival.

Advancing the age at which puberty and subsequent sexual maturation is attained in cattle is central to the reproductive and economic efficiency of both beef and dairy production systems worldwide. Onset of puberty in both male and female cattle is regulated by a complex network of biochemical processes and involves interaction among many key metabolic, neuroendocrine and reproductive tissues. Although our understanding of the biochemical interplay that conditions and eventually triggers the pubertal process has improved in recent years, much of the intricate mechanistic detail still eludes us. Environmental factors, such as nutritional management, as well as the genetic makeup of the animal undoubtedly affect the timing of puberty in cattle. In particular, there is now overwhelming evidence to support the importance of early life nutrition in regulating the timing of puberty in both bulls and heifers. For both genders, there is significant evidence that an improved metabolic status, early in calfhood, advances maturation of the hypothalamic-pituitary-gonadal axis, therefore facilitating earlier sexual development. Although advancing sexual maturation is a desirable goal, it is important that any strategy used does not impinge upon normal gametogenesis or postpubertal fertility potential. To this end, the aim of this review is to discuss the underlying biology of puberty in cattle with particular emphasis on the role of nutritional management during early calfhood in: (1) advancing the maturity of the hypothalamic-pituitary-gonadal axis; and (2) implications for the quality of gametes and subsequent fertility.

Catching measles in an appropriately vaccinated group: a well-circumscribed outbreak in the South East of Ireland, September-November 2013.

A measles outbreak occurred in a school in a small town in the South East of Ireland in September-November 2013. Most (and all early) cases had one dose of the measles-mumps- rubella (MMR) vaccination. All suspected cases were followed up, in order to advise on sampling and provide public health advice to them and their contacts. MMR vaccination control measures were instituted in the town. These included early second MMR in primary schools and childcare facilities, bringing forward the planned school MMR catch-up programme, early first MMR dose for children aged 6-12 months and targeted advice to unvaccinated children. There were 20 cases (17 confirmed) of measles associated with the outbreak. Fifteen cases occurred in the index school, with four in pre-school-age children (<4 years) who had clear epidemiological links with children at the school. This was a well-circumscribed outbreak occurring, unusually, in a well-vaccinated population. The outbreak came late to the attention of Department of Public Health staff but prompt action, once notified, and institution of control measures resulted in quick termination of the outbreak and prevention of cases in a neighbouring city.

A prolonged outbreak of invasive meningococcal disease in an extended Irish Traveller family across three Health Service Executive (HSE) areas in Ireland, 2010 to 2013.

Between March 2010 and November 2013 eight laboratory-confirmed cases of serogroup B, invasive meningococcal disease (IMD) were identified in an extended Irish Traveller family across three Health Service Executive (HSE) areas of Ireland. Cases were aged between 5 and 46 months, and were either a cousin or sibling of another case. All eight cases survived. Chemoprophylaxis was given to relevant nuclear family members and close contacts on each occasion, but failed to prevent further cases. Neisseria meningitidis isolates from six cases were highly related, belonging to the ST-41/44 clonal complex, and shared the porA designation 7­2,4. In November 2013, the outbreak control team recommended that directly observed ciprofloxacin chemoprophylaxis be administered simultaneously to the extended family, and that the four component meningococcal B (4CMenB) vaccine be administered to family members aged 2 months to 23 years inclusive and relevant close contacts of the eighth case. Subsequently these recommendations were implemented at three regional clinics. Additionally pharyngeal swabs (n=112) were collected to assess carriage rates of N. meningitidis in this extended family. Pharyngeal carriage of N. meningitidis was detected in 15 (13%) family members. From the epidemiological investigation and carriage study overcrowding was the most likely risk factor identified in this outbreak. To date, the combination of directly observed ciprofloxacin chemoprophylaxis and use of 4CMenB vaccine have controlled the outbreak with no further cases diagnosed.

Outbreak of hepatitis A infection associated with the consumption of frozen berries, Ireland, 2013--linked to an international outbreak.

In May 2013, a European alert was issued regarding a hepatitis A virus (HAV) outbreak in Italy. In June 2013, HAV subgenotype IA with an identical sequence was identified in Ireland in three cases who had not travelled to Italy. The investigation consisted of descriptive epidemiology, a case-control study, microbiological testing of human and food specimens, molecular typing of positive specimens and food traceback. We identified 21 outbreak cases (14 confirmed primary cases) with symptom onset between 31 January and 11 October 2013. For the case-control study, we recruited 11 confirmed primary cases and 42 matched controls. Cases were more likely than controls to have eaten berry cheesecake (matched odds ratio (mOR): 12; 95% confidence interval (CI): 1.3-114), whole frozen berries (mOR: 9.5; 95% CI: 1.0-89), yoghurt containing frozen berries (mOR: 6.6, 95% CI: 1.2-37) or raw celery (mOR: 4; 95% CI: 1.2-16). Among cases, 91% had consumed at least one of four products containing frozen berries (mOR: 12; 95% CI: 1.5-94). Sixteen food samples tested were all negative for HAV. As products containing frozen berries were implicated in the outbreak, the public were advised to heat-treat frozen berries before consumption.

Nosocomial outbreak of hepatitis B virus infection involving two hospitals in the Republic of Ireland.

The routes of nosocomial hepatitis B virus (HBV) transmission have changed over the years. Initiatives to prevent transfusion-associated HBV and healthcare worker-to-patient transmission have had a positive impact on these transmission routes. Recent reports of outbreaks of nosocomial HBV have implicated breaches in standard precautions as important causes of HBV transmission. This report describes a nosocomial outbreak of HBV infection in the Republic of Ireland, which occurred between January 2005 and March 2006. The outbreak was detected following identification of a case of acute HBV infection in a patient whose only risk factor was a recent surgical procedure. The extensive multi-agency investigation that followed revealed that the patient was one of five cases of acute HBV infection and that four separate transmission events between infectious cases had occurred in two different hospitals over a 15-month period. A definitive cause for each transmission event was not identified, although lapses in adherence to standard precautions, safe injection and phlebotomy practices could not be ruled out. Two secondary cases of acute HBV infection in community contacts of two of the nosocomial cases were identified. Phylogenetic analysis proved a useful tool in confirming infection with a pre-core HBV mutant and viral transmission between the seven patients. A patient notification exercise involving 1028 potentially exposed patients found no evidence of additional cases of nosocomial HBV infection. These findings highlight the importance of consistent application of standard precautions.

Psychosocial outcomes at 18 months after good neurological recovery from aneurysmal subarachnoid haemorrhage.

OBJECTIVES: To evaluate functioning, 18 months after surgery, of 49 patients with good neurological recovery following aneurysmal subarachnoid haemorrhage (SAH), and to determine the extent of any improvements in disturbances of mood, cognitive functioning, and levels of activity and participation previously observed at 9 month follow up. METHODS: SAH patients, matched for age, gender, and occupation with healthy control participants, completely quantitative measures of mood (HADS, FIES, BDI) and activity/participation (BICRO-39 scales), and a brief cognitive assessment battery (verbal fluency, digit span, prose recall). Controls completed the HADS and the BICRO-39. RESULTS: Patients showed some recovery of cognitive functioning, though impairments of prose recall persisted. Anxiety and depression symptoms were higher in patients than in controls, but fewer than 20% scored in the clinical range on any questionnaires except for RIES-Intrusive thoughts (22%); only three showed signs of full blown post-traumatic stress disorder. Almost half showed elevated dependence on others for domestic activities and organisation and abnormally low levels of employment. Very little variance in outcome was predicted by demographic variables, neurological or cognitive impairment, prior life stress, or mood. However, levels of social activity and self-organisation were related to persisting fatigue. CONCLUSIONS: The observed decline in intrusive thoughts and avoidance over time is consistent with that seen after life threatening illness or trauma. The persistent reductions in independence and levels of employment may in some cases reflect considered lifestyle adjustments rather than adverse and unwanted changes but in others indicate a need for focused rehabilitation.

Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis.

OBJECTIVES: To investigate (1) the prevalence of various aspects of cognitive and psychosocial dysfunction, including post-traumatic stress symptoms, over nine months after subarachnoid haemorrhage (SAH); (2) whether SAH is preceded by increased life stress; (3) to what extent adverse outcomes may be predicted from preillness life stress, early neurological impairment, age, and sex; and (4) relations between emotional and functional outcomes. METHODS: 52 patients with good neurological recovery after surgery for SAH were each matched for age, sex, and occupation with a healthy control participant. SAH patients were assessed three and nine months postdischarge on measures of cognitive functioning, mood, and social functioning. Objective stressors and subjective life change during the preceding year were rated retrospectively. Controls completed measures of mood and social functioning once only. RESULTS: Compared with controls, SAH patients showed increased mood disturbance, subtle cognitive impairment, and abnormally low independence and participation on measures of social functioning. 60% showed clinically significant post-traumatic stress symptomatology (intrusive thoughts or avoidance of reminders) at three months and 30% at nine months. Independence in activities of daily living was greatly reduced in half to a third of the sample at both three and nine months. Productive employment was below the 10th percentile of the control group for 75% of patients at three months and for 56% at nine months; this outcome could not be predicted from selected demographic, premorbid, or clinical variables but dependence on others for organisational activities was predicted by impaired prose recall. Mood at nine months was strongly predicted by prior mental health problems, poor physical health, dysphasia, and impaired prose recall at three months. There was no evidence of an abnormally high level of stressful life events in the year before SAH, although patients rated their subjective level of stress in this period slightly more highly than did the control participants. CONCLUSIONS: These findings highlight the need for structured support and treatment after surgery for SAH to reduce persisting mood disturbance and increase independence and participation.

Community based rehabilitation after severe traumatic brain injury: a randomised controlled trial.

OBJECTIVE: Evaluation of multidisciplinary community based outreach rehabilitation after severe traumatic brain injury (TBI). METHODS: A randomised controlled trial compared outreach treatment (mean of two sessions a week for 27.3 (SD 19.1) weeks) in community settings such as participants' homes, day centres, or workplaces, with provision of written information detailing alternative resources. Follow up for an average of 24.8 months after initial allocation was by a blinded independent assessor. Participants were aged 16-65, had sustained severe TBI between 3 months and 20 years previously, and had no other neurological conditions. Of 110 initially allocated, 48 outreach and 46 information participants were successfully followed up. Primary outcome measures (Barthel index (BI) and the brain injury community rehabilitation outcome-39 (BICRO-39)) focused on levels of activity and participation. Secondary measures were the functional independence measure and the functional assessment measure (FIM+FAM) and, in a subgroup of 46 participants, the hospital anxiety and depression scale. Analyses were non-parametric. RESULTS: outreach participants were significantly more likely to show gains on the BI and the BICRO-39 total score and self organisation and psychological wellbeing subscales. There were likewise strong trends (p<0.10) for BICRO personal care and mobility, and on the FIM+FAM for personal care and cognitive functions. Differential improvements were not seen for indices of socializing, productive employment, anxiety, or depression. Median changes on individual subscales were small, reflecting the diversity of the clinical population; however, 40% of outreach but only 20% of information participants made a clinically significant improvement of 2+ points on at least one BICRO-39 scale. Time since injury was unrelated to the magnitude of gains. CONCLUSIONS: This is the first RCT of multidisciplinary community rehabilitation after severe TBI, and suggests that even years after injury it can yield benefits which outlive the active treatment period.

Health status and service utilisation of older people in different European countries.

OBJECTIVE: Care of elderly demands more and more resources. The purpose of this study was to compare the health of the elderly and the differences in utilisation of services. DESIGN: Health status was measured using the Short Form 36, the Barthel Index of Activities of Daily Living, the Abbreviated Mental Test and the Hospital Anxiety and Depression Scale. Information was also obtained on health and social service utilisation. SETTING: Eight European districts. SUBJECTS: 4004 elderly aged 70-94 years were studied. RESULTS: General health perception measured with SF-36 was significantly better in men than in women and in elderly living outside institutions. Measured with the Barthel scale, the elderly living in the southern districts were more disabled. Women were more disabled than men. Depression and anxiety were common, but inadequately treated and strongly linked with disability. There was a north-south difference also in mental disability, people in the north feeling healthier. CONCLUSION: Cultural differences probably explain most of the differences observed. However, treating depression and anxiety more adequately could help elderly people to avoid early institutionalisation.

Integrating the Jewish Dietary Laws into a dietetics program. Kashruth in a dietetics curriculum.

A clinical and community dietetics program integrates Kashruth, the Jewish Dietary Laws, into its curriculum. Simply defined, kosher means fit for consumption. Emblems used throughout the United States and Canada to indicate a program of rabbinic endoresment and supervision of canned, boxed, and bottled products are included. An existing kosher unit is described, and guidelines for establishing a kosher food science laboratory unit are offered. Suggestions for instituting kosher foodservice in health care facilities are given. Therapeutic applications of Kashruth are suggested, and approved therapeutic food products are listed.