Resource Estimations in Contingency Planning for Foot-and-Mouth Disease.

Preparedness planning for a veterinary crisis is important to be fast and effective in the eradication of disease. For countries with a large export of animals and animal products, each extra day in an epidemic will cost millions of Euros due to the closure of export markets. This is important for the Danish husbandry industry, especially the swine industry, which had an export of €4.4 billion in 2012. The purposes of this project were to (1) develop an iterative tool with the aim of estimating the resources needed during an outbreak of foot-and-mouth disease (FMD) in Denmark, (2) identify areas, which can delay the control of the disease. The tool developed should easily be updated, when knowledge is gained from other veterinary crises or during an outbreak of FMD. The stochastic simulation model DTU-DADS was used to simulate spread of FMD in Denmark. For each task occurring during an epidemic of FMD, the time and personnel needed per herd was estimated by a working group with expertise in contingency and crisis management. By combining this information, an iterative model was created to calculate the needed personnel on a daily basis during the epidemic. The needed personnel was predicted to peak within the first week with a requirement of approximately 123 (65-175) veterinarians, 33 (23-64) technicians, and 36 (26-49) administrative staff on day 2, while the personnel needed in the Danish Emergency Management Agency (responsible for the hygiene barrier and initial cleaning and disinfection of the farm) was predicted to be 174 (58-464), mostly recruits. The time needed for surveillance visits was predicted to be the most influential factor in the calculations. Based on results from a stochastic simulation model, it was possible to create an iterative model to estimate the requirements for personnel during an FMD outbreak in Denmark. The model can easily be adjusted, when new information on resources appears from management of other crisis or from new model runs.

[Risk factors for peptic ulcer bleeding]. / Risikofaktorer for blødende magesår.

BACKGROUND: Many drugs increase the risk for gastroduodenal ulcer bleeding. The aim of this study was to investigate Helicobacter pylori infection and drug use in patients who had gastroduodenal ulcer bleeding in 2002 or 2007, and possible differences between the periods. MATERIAL AND METHODS: Patients with gastroduodenal ulcer bleeding were prospectively included in the periods 1.1 - 31.12. 2002 and 1.1 - 31.12. 2007. Information was recorded about Helicobacter pylori infection and intake of NSAIDs (non steroidal anti-inflammatory drugs), acetylsalicylic acid, warfarin, clopidogrel, low-molecular heparine, SSRIs (selective serotonin reuptake inhibitors), corticosteroids, paracetamol and proton pump inhibitors. Inhabitants in Oslo age >or= 60 years in 2007, were used as a control for drug use. RESULTS: 78.2 % of patients in 2002 and 90.7 % of those in 2007 used at least one of the drugs (p = 0.01). In 2002, 25.7 % of patients used non-selective NSAIDs and in 2007 46.1 % used such drugs (p = 0.001). In 2002, 36.7 % of patients used more than one of the studied drugs, versus 50.9 % in 2007 (p = 0.02). Compared to controls, the patients used more NSAIDs, acetylsalicylic acid, clopidogrel, low- molecular heparine, SSRIs and corticosteroids. Helicobacter pylori infection was diagnosed in 51.0 % of patients in 2002, versus 41.1 % in 2007 (p = 0.11). INTERPRETATION: Most patients with gastroduodenal ulcer bleeding use drugs that have a known risk of adverse effects such as ulcer and/or gastrointestinal bleeding.

[Antiplatelet therapy after aspirin-induced upper gastrointestinal bleeding]. / Platehemmerbehandling ved tidligere gastrointestinal blødning forårsaket av acetylsalisylsyre.

It is common practice to replace aspirin with clopidogrel in patients with gastrointestinal intolerance to aspirin. Recent studies suggest that a combination of aspirin and a proton pump inhibitor is a better alternative for these patients. The CAPRIE and CURE studies have not shown any clinically relevant difference in effect between aspirin and clopidogrel. The incidence of bleeding is also similar when aspirin is used in doses < 160 mg. A recent study by Chan et al. concluded that a combination of aspirin and esomeprazole is superior to clopidogrel in the prevention of recurrent gastrointestinal bleeding. Using aspirin and a proton pump inhibitor is also the least expensive alternative.