The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study.

Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly. To our knowledge, the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn. We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly, and would bring about concomitant benefits in body composition and muscle power. Accordingly, this exercise and nutritional combination was assessed in the frail elderly in a 9-month randomised trial with a factorial design. Fifty-seven elderly volunteers over 72 years, from sixteen retirement homes in Lyon, France participated in the study. Dietary supplements were compared with placebo, and physical exercise was compared with memory training. Main outcome measures were fat-free mass (FFM) and muscle power. FFM was determined by labelled water, and muscle power was measured by a leg-extensor machine. At 9 months, the compliance was 63 % for exercise sessions, and 54 % for nutritional supplements. In patients with dietary supplements, muscle power increased by 57 % at 3 months (P=0.03), and showed only a tendency at 9 months; although FFM increased by 2.7 % at 9 months, the difference was not significant (P=0.10). Exercise did not improve muscle power at 9 months, but improved functional tests (five-time-chair rise, P=0.01). BMI increased with supplements (+3.65 %), but decreased with placebo (-0.5 %) at 9 months (P=0.007). A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance. Nutritional supplements and exercise may improve muscle function. Despite no significant results on FFM, due to the limited number of volunteers, combined intervention should be suggested to counteract muscle weakness in the frail elderly.

The non-insulin-dependent diabetes, hypertension, microalbuminuria or proteinuria, cardiovascular events, and ramipril (DIABHYCAR) study: design, organization, and patient recruitment. DIABHYCAR Study Group.

The non-insulin-dependent DIABetes, HYpertension, microalbuminuria or proteinuria, CARdiovascular events, and Ramipril (DIABHYCAR) study is a randomized, prospective, double-blind, placebo-controlled, multicenter international trial of the ACE inhibitor ramipril (1.25 mg/day) in patients with type II diabetes and micro- or macroalbuminuria. The main outcome of the study is the time to first occurrence of either death from a cardiovascular origin, including sudden death, nonfatal myocardial infarction, stroke, or congestive heart failure, or requirement of hemodialysis or renal transplantation. The study was launched in France in early 1995 with the participation of general practitioners only, but had to be extended to 15 other countries in 1997 due to difficulties in recruitment. Since 2.5 years after the beginning of the trial the observed event rate was much less than anticipated, it was decided to increase recruitment and follow-up duration and to include congestive heart failure in the definition of the main outcome to keep the study power at a satisfactory level. Recruitment ended on April 1, 1998 with 4937 randomized patients. Following the early discontinuation for efficacy of another study of ramipril in high cardiovascular risk patients, the Heart Outcomes Prevention Evaluation study (HOPE), the second interim analysis of DIABHYCAR was performed early (when 406 instead of 500 patients presented a main outcome) and the Data Safety and Monitoring Board recommended that the study continue. Follow-up is planned to end on March 31, 2001.

A field study on estrus detection in lactating beef cattle.

Estrus detection efficacy and heat detection protocol were studied by means of a field study carried out on 878 lactating beef cows in 60 French herds. Average herd size was 48, and 75% of the farmers partly or exclusively used artificial insemination. The cows were calved between October 1992 and March 1993. Estrus was recorded daily by the farmers. Cycling status was determined by progesterone radioimmuno-assay 2 months after calving. The relationship between the estrus detection protocol and the delay period from calving to first observed estrus was analysed using survival curves and the Cox proportional hazard model, adjusting for confounders. Seventy-one percent of the cows were seen in estrus by the farmers; the interval between calving and the first observed estrus ranged from 9 days to more than 5 months and the median was 56 days. Two months after calving, 44% of the cycling cows had not been seen in heat by the farmers and 11% of the non-cycling cows had been reported to have been in estrus. The heat detection protocol varied widely between farmers, depending on the considered estrus signs, schedule and time spent looking for signs. Two factors were significantly related to a shorter interval from calving to first observed heat: the use of artificial insemination (which relates to the farmer's interest in heat detection) and an overall daily time spent for heat detection greater than 1 h. Cows in tie stalls had a delayed interval to the first observed estrus. These results show that many farmers did not adapt their reproduction practice sufficiently to an earlier calving period. There is room for improvement since in many cases the heat detection protocol does not match the required standards for optimal heat detection.

[Assessing the accuracy of the practice of a method of scoring the body condition of ewes within a professional framework]. / Appréciation de la fidélité de la pratique d'une méthode de notation de l'état corporel des brebis dans un cadre professionnel.

The accuracy of the body condition scoring for ewes using lumbar palpation was assessed by mean of an experiment conducted under conditions close to those occurring everyday on the farms. Thirteen operators evaluated the body condition score twice in a sample of 48 Lacaune breed dairy ewes, using a semi-quantitative grid (from 0 to 5 points, with a 0.25 point precision). Under the experimental conditions, the repeatability of the method, i.e. the comparison between the scores given by the same operator to the same animals for the two successive scoring notations, was good and even very good (Kappa test), if a 0.25 point precision is tolerated. On the other hand, the reproducibility, i.e. the comparison between the scores given to the same animals by differents operators was poor. Therefore, this method is easy to master for the management of a given flock by a single person. However in order to make comparisons between flocks, in reference to body condition standards set up for different farming systems, this method needs greater precision. Some of the application conditions required for this are discussed.

Postpartum anestrus in French beef cattle: an epidemiological study.

Postpartum anestrus of lactating beef cows was studied by means of an epidemiological study carried out on 878 lactating beef cows in 60 French herds. The cows calved between October 1992 and March 1993 and were housed 2 mo after calving, when the anestrus status was determined by progesterone radioimmunoassays. Data analysis was performed using a multiple logistic model in order to adjust for confounding and interaction. Fifty-one percent of the primiparous and 23% of the multiparous cows were found to be in anestrus. Factors significantly related to anestrus were parity (primiparous); breed (Charolais); housing type (tie housing); suckling (compared to weaning at birth); and, among those that were under the control of the farmer, calving conditions (manual exploration of the birth canal); body condition score at calving (3 or less, on a 5-point scale); and loss in body condition score after calving (1 point or more within 2 mo). Previous reproductive performance for multiparous cows such as a long calving interval and induced estrus in the previous year also appeared to be related to anestrus.

Databases save time and improve the quality of the design, management and processing of ecopathological surveys.

The example of an ecopathological survey on nursing ewe mastitis shows that data bases have 4 complementary functions: assistance during the conception of surveys; follow-up of surveys; management and quality control of data; and data organization for statistical analysis. This is made possible by the simultaneous conception of both the data base and the survey, and by the integration of computer science into the work of the task group that conducts the survey. This methodology helps save time and improve the quality of data in ecopathological surveys.

Advantages and inconveniences of the Cox model compared with the logistic model: application to a study of risk factors of nursing cow infertility.

The survival Cox model and the logistic model were compared on a data set obtained from an ecopathological survey relative to the risk factors of nursing cow infertility. The risk factors resulting from the 2 models were the same. The Cox model has the advantage of preserving the variable in its original quantitative form, and of using a maximum of information. However, very restrictive conditions of application of this model make its use rather limited.

Risk factors for infertility in nursing cows linked to calving.

An ecopathological survey was conducted between 1987 and 1989 in 116 French herds with 3,590 cows in order to study the risk factors for infertility linked to calving. Based upon an analysis model of etiological interactions, the complementary use of a logistic model and factorial analysis followed by classification allowed demonstration of the direct and indirect, effects upon infertility, breed factors, parity, fattening, comfort, calf characteristics (number, sex, weight, presentation), as well as the difficulty and complications which may have been associated with calving. By association, these factors determine the profile of the cows at risk.

Risk factors of dairy cow lameness associated with housing conditions.

In 1987, an ecopathology survey was carried out in 160 French dairy farms in order to specify lesions typical of laminitis and heelhorn erosion and to assess their risk factors. Three podal affections were characterized: chronic laminitis; subacute laminitis; and heelhorn erosion. Concerning the building for livestock, the risk factors of heelhorn erosion were associated with poor hygiene, while the risk factors of subacute laminitis were linked to uncomfortable housing conditions: high steps and slopes, and discomfort when lying down and getting up. No risk factor of chronic laminitis linked to the building for livestock was identified.

Study of a prevention programme for caprine arthritis-encephalitis.

A prevention programme for caprine viral arthritis-encephalitis was monitored in 363 goat herds between 1988 and 1990. The level of contamination in the female kids fell from 49.5 to 25% by the end of the 2-yr period during which the programme was applied. Some 19% of the female kids that had been substitute colostrum (cow colostrum or goat colostrum heated to 56 degrees C for 1 h) were contaminated compared with 45% of those that had been given raw colostrum. The segregation between the animals submitted to prevention measures and those that were not are presented to illustrate the efficiency of prevention of horizontal transmission.