An Outbreak Associated with Streptococcus equi Subsp. zooepidemicus in Layers: Evidence of Fecal Transmission.

Major disease outbreaks caused by Streptococcus equi subsp. zooepidemicus seldom are reported in poultry. Besides acute septicemia, infection can result in a subacute or chronic form of disease with described mortality rates of 11% to 80%. Previously, the source of infection in poultry was linked to horses in which this bacterium can be present as an opportunistic pathogen on mucus membranes. The main route of spreading and being maintained within a poultry flock, after entering the stable, however, remains unclear. This case report describes an outbreak associated with S. zooepidemicus affecting a flock of 28 500 layer hens housed in an aviary system with free range. Besides sudden deaths, clinical signs of depression were noticed. Between 44 and 61 wk of age a total mortality of 23% was observed. Egg production dropped from 92% to 83%. Bacterial titration revealed substantial numbers of S. zooepidemicus present in the ceca of a healthy chicken. This novel finding hypothesizes that transmission of the infection within the flock might occur through the fecal route.

Adenoviral Gizzard Erosions in Two Belgian Broiler Farms.

Fowl adenovirus infections are widely prevalent in poultry. Many of the viruses can infect chickens without resulting in overt disease. Nevertheless, some fowl adenoviruses can cause important disease complexes in chickens such as inclusion body hepatitis, hydropericardium syndrome, necrotic pancreatitis, and gizzard erosion. Adenoviral gizzard erosions have been regularly reported from Japan, but detailed reports from Europe are scarce and available only from Italy, Poland, Hungary, and Germany. This case report describes two concurrent outbreaks of gizzard erosions caused by fowl adenovirus A in two Belgian broiler farms. Clinical signs observed were signs of depression, reduced feed intake, reduced weight gain, and lack of uniformity of the flocks. At necropsy, typically multiple erosions within the koilin layer of the gizzard were observed. Histopathological examination showed a multifocal, erosive ventriculitis with basophilic intranuclear inclusions in the epithelium. PCR analysis confirmed the diagnosis of fowl adenovirus. These findings suggest that outbreaks of adenoviral gizzard erosion can also lead to significant economic losses in Belgium.

Persistent Goose Hemorrhagic Polyomavirus Infection on a Belgian Goose Farm.

Goose hemorrhagic polyomavirus (GHPV) is the causative agent of hemorrhagic nephritis enteritis of geese (HNEG), one of the major diseases of domestic geese in Europe. This case report describes a persistent outbreak of a GHPV infection on a Belgian goose farm. Clinical symptoms, necropsy lesions, and histopathologic lesions observed were compatible with previous reports of HNEG outbreaks. PCR analysis confirmed the diagnosis of GHPV. To our knowledge, this is the first report of an outbreak of a GHPV infection on a Belgian goose farm. This is evidence that GHPV is not only present in countries known for extensive waterfowl production, but disease outbreaks also occur in countries with less extensive goose production.

Carbon isotope compositions (δ(13) C) of leaf, wood and holocellulose differ among genotypes of poplar and between previous land uses in a short-rotation biomass plantation.

The efficiency of water use to produce biomass is a key trait in designing sustainable bioenergy-devoted systems. We characterized variations in the carbon isotope composition (δ(13) C) of leaves, current year wood and holocellulose (as proxies for water use efficiency, WUE) among six poplar genotypes in a short-rotation plantation. Values of δ(13) Cwood and δ(13) Cholocellulose were tightly and positively correlated, but the offset varied significantly among genotypes (0.79-1.01‰). Leaf phenology was strongly correlated with δ(13) C, and genotypes with a longer growing season showed a higher WUE. In contrast, traits related to growth and carbon uptake were poorly linked to δ(13) C. Trees growing on former pasture with higher N-availability displayed higher δ(13) C as compared with trees growing on former cropland. The positive relationships between δ(13) Cleaf and leaf N suggested that spatial variations in WUE over the plantation were mainly driven by an N-related effect on photosynthetic capacities. The very coherent genotype ranking obtained with δ(13) C in the different tree compartments has some practical outreach. Because WUE remains largely uncoupled from growth in poplar plantations, there is potential to identify genotypes with satisfactory growth and higher WUE.

Biocheck.UGent: a quantitative tool to measure biosecurity at broiler farms and the relationship with technical performances and antimicrobial use.

The Biocheck.UGent scoring system has been developed to measure and quantify the level of biosecurity on broiler farms. This tool is composed of all relevant components of biosecurity on broiler farms and is subdivided into external (purchase of 1-d-old chicks, off-farm movements of live animals, feed and water supply, removal of manure and dead birds, entrance of visitors and personnel, supply of materials, infrastructure and biological vectors, location of the farm) and internal (disease management, cleaning and disinfection, materials, and measures between compartments) biosecurity. The unique feature of this scoring system is that it takes the relative importance of the different biosecurity aspects into account, resulting in a risk-based weighted score. The Biocheck.UGent scoring system and accompanying questionnaire can be filled in for free at www.Biocheck.UGent.be. The obtained biosecurity scores are provided immediately after completion of the questionnaire, and the scores for each subcategory can be compared with national averages to allow the farmer to benchmark the obtained results to his colleagues. Preliminary results (n = 15) show a huge range in the biosecurity level on broilers farms in Belgium, with internal biosecurity scores ranging from 54/100 to 87/100 and external biosecurity scores ranging from 55/100 to 72/100. These first results show that despite the well-known importance of biosecurity, there's a lack of implementation of many biosecurity measures and room for improvement.

Seasonal variations in photosynthesis, intrinsic water-use efficiency and stable isotope composition of poplar leaves in a short-rotation plantation.

Photosynthetic carbon assimilation and transpirational water loss play an important role in the yield and the carbon sequestration potential of bioenergy-devoted cultures of fast-growing trees. For six poplar (Populus) genotypes in a short-rotation plantation, we observed significant seasonal and genotypic variation in photosynthetic parameters, intrinsic water-use efficiency (WUEi) and leaf stable isotope composition (δ13C and δ18O). The poplars maintained high photosynthetic rates (between 17.8 and 26.9 µmol m(-2) s(-1) depending on genotypes) until late in the season, in line with their fast-growth habit. Seasonal fluctuations were mainly explained by variations in soil water availability and by stomatal limitation upon photosynthesis. Stomatal rather than biochemical limitation was confirmed by the constant intrinsic photosynthetic capacity (Vcmax) during the growing season, closely related to leaf nitrogen (N) content. Intrinsic water-use efficiency scaled negatively with carbon isotope discrimination (Δ13Cbl) and positively with the ratio between mesophyll diffusion conductance (gm) and stomatal conductance. The WUEi-Δ13Cbl relationship was partly influenced by gm. There was a trade-off between WUEi and photosynthetic N-use efficiency, but only when soil water availability was limiting. Our results suggest that seasonal fluctuations in relation to soil water availability should be accounted for in future modelling studies assessing the carbon sequestration potential and the water-use efficiency of woody energy crops.

High seroprevalence of respiratory pathogens in hobby poultry.

Seroprevalence studies on respiratory pathogens have been done extensively in commercial laying hens, broilers, and, to a lesser extent, backyard poultry. In Europe, seroprevalence studies in backyard and fancy breed poultry flocks are scarce and limited to a few pathogens, such as Mycoplasma gallisepticum (MG); others, such as Ornithobacterium rhinotracheale (ORT), are missing. A commercial ELISA for detection of antibodies against six selected pathogens was performed on 460 serum samples from chickens across Flanders. Anti-ORT antibodies were, by far, the most prevalent, with a prevalence of 95.4%. Infectious bronchitis virus, Mycoplasma synoviae, and avian metapneumovirus antibodies were found in 75.6%, 76.3%, and 63.5% of the animals, respectively. Antibodies against MG and infectious laryngotracheitis virus were found in 36.7% and 30% of the animals, respectively. These data demonstrate the high seroprevalence of respiratory pathogens among hobby poultry; therefore, it is possible that this group could act as a reservoir for commercially kept poultry.

In vitro sensitivity of poultry Brachyspira intermedia isolates to essential oil components and in vivo reduction of Brachyspira intermedia in rearing pullets with cinnamaldehyde feed supplementation.

Cecal enteritis due to Brachyspira infections tends to be chronic in laying hens. Limited availability of antimicrobial drugs for use in laying hens emphasizes the need for alternative control measures. A broth microdilution method was used to determine the antimicrobial susceptibility of 20 Brachyspira intermedia field isolates from laying hen flocks to components of essential oils (EO). Minimal inhibitory concentration (MIC) distributions, obtained for 8 EO components, were all monomodal. Cinnamaldehyde had the lowest MIC values (40 to 80 mg/L), followed by nerolidol, capsaicin, carvacrol, and thymol (80 to 320 mg/L), eugenol (160 to 640 mg/L), and linalool (320 to 1,280 mg/L). The MIC ranges of piperine were mostly above the test range of 1,280 mg/L. In an in vivo experiment, coated trans-cinnamaldehyde was supplemented to the feed of rearing pullets. A completely randomized experimental design with 4 treatments and 3 replicates each (replicate = group of seven 1-d-old laying hen chickens) was applied. The negative and positive controls received a conventional feed during the whole trial. The positive controls were orally inoculated on 3 consecutive days (d 22, 23, and 24) with 1 mL of 1.0 × 10(8) cfu/mL of a B. intermedia field isolate. Two treatment groups (preventive and curative), identically inoculated, received the coated trans-cinnamaldehyde-supplemented feed (500 mg/kg of trans-cinnamaldehyde), the preventive group from d 1, the curative from d 25. On d 32, ceca were collected for bacteriologic Brachyspira enumeration. The mean enumeration of Brachyspira cells was decreased (P < 0.05) in the curative treated group versus the positive control group. The in vitro results of the present study demonstrate the potential of EO components as antimicrobials against poultry Brachyspira isolates, including isolates with acquired resistance for classic antimicrobial drugs. Reduction of Brachyspira colonization in young pullets was obtained, in a curative way, in an in vivo study using feed supplemented with coated trans-cinnamaldehyde. Further studies are necessary to investigate the mode of action of the coated trans-cinnamaldehyde in reducing Brachyspira colonization of the ceca.

Soil CO2 efflux in a bioenergy plantation with fast-growing Populus trees - influence of former land use, inter-row spacing and genotype.

AIMS: In this study we quantified the annual soil CO2 efflux (annual SCE) of a short rotation coppice plantation in its establishment phase. We aimed to examine the effect of former (agricultural) land use type, inter-row spacing and genotype. METHODS: Annual SCE was quantified during the second growth year of the establishment rotation in a large scale poplar plantation in Flanders. Automated chambers were distributed over the two former land use types, the two different inter-row spacings and under two poplar genotypes. Additional measurements of C, N, P, K, Mg, Ca and Na concentrations of the soil, pH, bulk density, fine root biomass, microbial biomass C, soil mineralization rate, distance to trees and tree diameters were performed at the end of the second growth year. RESULTS: Total carbon loss from soil CO2 efflux was valued at 589 g m-2 yr-1. Annual SCE was higher in former pasture as compared to cropland, higher in the narrow than in the wider inter-row spacings, but no effect of genotype was found. CONCLUSIONS: Spatial differences in site characteristics are of great importance for understanding the effect of ecosystem management and land use change on soil respiration processes and need to be taken into account in modeling efforts of the carbon balance.

Importance of crown architecture for leaf area index of different Populus genotypes in a high-density plantation.

Crown architecture is an important determinant of biomass production and yield of any bio-energy plantation since it determines leaf area display and hence light interception. Four Populus genotypes-of different species and hybrids and with contrasting productivity and leaf area-were examined in terms of their branch characteristics in relation to crown architecture during the first and second growing seasons after plantation establishment. The trees were planted at high density (8000 ha(-1)) on two different former land use types, cropland and pasture. We documented significant differences in branch architecture among the genotypes and for the first year among the former land use types. Land use effects only affected factors not related to canopy closure and wood production, and decreased after the first growing season. This suggested that both former land use types were equally suited for the establishment success of a poplar bio-energy plantation. Tree height and branch dimensions-branch diameter and branch length-were the most important determinants of wood production and maximum leaf area index. Despite the secondary importance of the number of sylleptic branches, these branches contributed significantly to the total leaf area in three out of the four studied genotypes. This indicated that enhanced syllepsis accelerates leaf area development and hence carbon assimilation, especially in the early stages of a high-density plantation with poplar.

Application of medium-chain fatty acids in drinking water increases Campylobacter jejuni colonization threshold in broiler chicks.

Campylobacteriosis is the most reported bacterial-mediated gastroenteritic disease in many developed countries. Broiler chickens are a natural host for Campylobacter spp., and contaminated poultry meat products are a major source for transmitting pathogenic Campylobacter strains to humans. Currently, no intervention measure efficiently and effectively controls this pathogen in poultry flocks. Medium-chain fatty acids (caproic, caprylic, capric, and lauric acids) show a marked anti-Campylobacter activity in vitro. However, in recent trials using our in vivo models, administering these acids to the feed of broiler chicks neither prevented nor reduced cecal C. jejuni colonization in broilers. In the present study, we examined whether a drinking water application of medium-chain fatty acids might be more effective in combating Campylobacter colonization in poultry. Although Campylobacter colonization and transmission was not reduced, we demonstrate that adding an emulsion of a mixture of caproic, caprylic, capric, and lauric acids to the drinking water of broiler chicks reduces their colonization susceptibility and prevents C. jejuni survival in drinking water. Thus, the merit of water applications of medium-chain fatty acids is the reduction of the probability of Campylobacter entry into and transmission throughout a flock.

Intestinal mucus protects Campylobacter jejuni in the ceca of colonized broiler chickens against the bactericidal effects of medium-chain fatty acids.

Campylobacter jejuni is the most common cause of bacterial-mediated diarrheal disease worldwide. Because poultry and poultry products are a major source of C. jejuni infections in humans, efforts should be taken to develop strategies to decrease Campylobacter shedding during primary production. For this purpose, the efficacy of medium-chain fatty acids (MCFA) as feed additives to control C. jejuni colonization in broiler chickens was analyzed. First, the antimicrobial activity of the MCFA caproic, caprylic, and capric acid on C. jejuni was evaluated in vitro. Minimal inhibitory concentrations were 0.25 mM for caproic and 0.5 mM for caprylic and capric acids at pH 6.0 and 4 mM for all 3 compounds at pH 7.5. Time-kill curves revealed strong bactericidal properties of the tested compounds toward C. jejuni at pH 6.0. Concentrations as low as 4 mM caprylic and capric acids and 16 mM caproic acid killed all bacteria within 24 h. Capric acid had the highest activity, with concentrations of 4 mM killing all bacteria within the hour. Together these data show a profound bactericidal, dose-dependent activity of the tested MCFA toward C. jejuni in vitro. For this reason, the effect of these 3 MCFA on C. jejuni was evaluated in vivo. The addition of any of the acids to the feed, from 3 d before euthanization, was not capable of reducing cecal Campylobacter colonization in 27-d-old broilers experimentally infected with C. jejuni at 15 d of age. Using a cecal loop model, sodium caprate was not able to reduce cecal Campylobacter counts. When time-kill curves were conducted in the presence of chick intestinal mucus, capric acid was less active against C. jejuni. At 4 mM, all bacteria were killed only after 24 h. Thus, despite the marked bactericidal effect of MCFA in vitro, supplementing these acids to the feed does not reduce cecal Campylobacter colonization in broiler chickens under the applied test conditions, probably due to the protective effect of the mucus layer.

Efficacy of a motilin receptor agonist (ABT-229) for the treatment of gastro-oesophageal reflux disease.

BACKGROUND: ABT-229 is a potent motilin agonist without significant antibiotic activity. It has been shown to improve gastric emptying in humans and to increase lower oesophageal sphincter pressure in cats. AIM: To assess the efficacy of four different doses of ABT-229 (1.25 mg, 2.5 mg, 5 mg, 10 mg b.d.) compared to placebo in the treatment of gastro-oesophageal reflux disease, and to determine its safety in patients with gastro-oesophageal reflux disease. METHODS: In a double-blind, multicentre study, 324 patients with heartburn were randomized to receive four different doses of ABT-229 or placebo for 8 weeks. The efficacy was evaluated by Patient Symptom Questionnaire, daily diary, endoscopy and global evaluation of efficacy. RESULTS: There were no statistically significant improvement scores for any of the ABT-229 treatment groups vs. the placebo group in any of the efficacy parameters. Reflux symptom scores were significantly worse after treatment in the dyspeptic group. ABT-229 appeared to be well tolerated and safe in total daily doses up to 20 mg. CONCLUSION: ABT-229 appears to have limited, if any, clinical utility in the treatment of gastro-oesophageal reflux disease.

Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial.

INTRODUCTION: Erythromycin, a motilin agonist, is a potent prokinetic. ABT-229 is a specific motilin agonist that dose dependently accelerates gastric emptying. Dyspepsia and gastroparesis are common problems in type 1 diabetes mellitus. We aimed to evaluate the efficacy of ABT-229 in symptomatic diabetic patients with and without delayed gastric emptying. METHODS: Patients with type 1 diabetes and postprandial symptoms were randomised (n=270). Based on a validated C(13) octanoic acid breath test, patients were assigned to either the delayed or normal gastric emptying strata. Patients received one of four doses of ABT-229 (1.25, 2.5, 5, or 10 mg twice daily before breakfast and dinner) or placebo for four weeks following a two week baseline. A self report questionnaire measured symptoms on visual analogue scales; the primary outcome was assessment of change in the total upper abdominal symptom severity score (range 0-800 mm) from baseline to the final visit. RESULTS: The treatment arms were similar regarding baseline characteristics. There was symptom improvement on placebo and a similar level of improvement on active therapy for the upper abdominal discomfort severity score (mean change from baseline -169, -101, -155, -143, and -138 mm for placebo, and 1.25, 2.5, 5, and 10 mg ABT-229, respectively, at four weeks by intent to treat). The results were not significantly different in those with and without delayed gastric emptying. The severity of bloating, postprandial nausea, epigastric discomfort, heartburn, and acid regurgitation worsened dose dependently in a greater number of patients receiving ABT-229 than placebo. Overall, 63% of patients on placebo reported a good or excellent global response, and this was not different from the active treatment arms. CONCLUSIONS: The motilin agonist ABT-229 was not efficacious in the relief of postprandial symptoms in diabetes mellitus in the presence or absence of delayed gastric emptying.

Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?

OBJECTIVE: Different subgroups can be identified in functional dyspepsia based on symptom type or severity, and may correlate with pathophysiological disturbances. In particular, female sex and severe fullness and vomiting have been reported to be strong independent predictors of slow solid gastric emptying. We aimed to determine if symptom patterns or severity could identify those with abnormal gastric emptying among patients with dysmotility-like functional dyspepsia and, for comparison, type I diabetes mellitus. METHODS: Patients with postprandial symptoms and documented functional dyspepsia by endoscopy (n = 551) and patients with type I diabetes who had postprandial dyspepsia (n = 247) enrolling in two separate randomized controlled trials were evaluated at baseline. Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated C13 octanoic acid breath test with sampling over 4 h. A self-report questionnaire measured the presence and severity of eight symptoms on visual analog scales. The validated Nepean Dyspepsia Index measured the frequency, severity, and bothersomeness of 15 upper GI symptoms on Likert scales. RESULTS: Gastric emptying was definitely delayed (t1/2 > 192 min) in 24% of patients with functional dyspepsia and 28% with diabetes. Delayed gastric emptying was associated with female gender but not age or Helicobacter pylori status. The age- and sex-adjusted risk (odds ratio) of delayed gastric emptying for the upper GI symptoms ranged from 0.99 to 1.0 (all p values > or =0.2). The results were very similar in functional dyspepsia and diabetes. There was also no correlation between t1/2 and number of symptoms or symptom severity scores. CONCLUSIONS: Symptom prevalence and severity were similar in dyspeptic patients with and without delayed gastric emptying. Specific symptoms do not seem to be of predictive value in dysmotility-like dyspepsia for identifying alterations of gastric emptying.

Efficacy of cisapride and domperidone in functional (nonulcer) dyspepsia: a meta-analysis.

BACKGROUND: The efficacy of prokinetic agents in functional (nonulcer) dyspepsia has been questioned based on recent trial results. We performed a meta-analysis to determine the efficacy of cisapride and domperidone in functional dyspepsia. METHODS: Computer and manual searching was used to identify placebo-controlled studies that included >20 patients. The statistical analysis focused on: global assessment by the investigator, epigastric pain, early satiety, abdominal distension and nausea (all rated on four-point scales). Results are reported as odds ratios (OR) in favor of treatment. Regression analysis was performed to evaluate possible effect modifiers. The relationship between improvement in gastric emptying and symptoms was also evaluated. RESULTS: For cisapride, 17 studies met the inclusion criteria, but varying numbers of studies had to be used for the different outcome measures. For all outcome measures, there was a statiscally significant benefit in favor of cisapride: global assessment of improvement by the investigator or patient (OR 2.9, 95% CI 1.5-5.8), epigastric pain (OR 0.19, 95% CI 0.05-0.7), early satiety (OR 0.18, 95% CI 0.9-0.4), abdominal distension (OR 0.32, 95% CI 0.1-0.7), and nausea (OR 0.26, 95% CI 0.1-0.5). Age of patient, year of publication, and country where study was performed had only small modifying effects. There were insufficient data to determine whether there is a relationship between improvement in gastric emptying and response to treatment. For domperidone, four of eight studies could be used for the analysis of global assessment of improvement by the investigator. This showed an OR of 7.0 (95% CI 3.6-16) in favor of domperidone. CONCLUSIONS: Both cisapride and domperidone seem to be efficacious in functional dyspepsia, although this conclusion is largely based on global assessment by the investigator, which may not be an optimal outcome measure.

Quality of life in functional dyspepsia: responsiveness of the Nepean Dyspepsia Index and development of a new 10-item short form.

BACKGROUND: The Nepean Dyspepsia Index is a reliable and valid measure of quality of life in functional dyspepsia, but responsiveness has been little studied. The Nepean Dyspepsia Index originally contained 42 items designed to measure impairment of a subject's ability to engage in relevant aspects of their life because of dyspepsia, and their enjoyment of these aspects; in addition, the individual importance of areas was assessed. It was subsequently shortened to 25 items, yielding five sub-scales. AIM: To test the Nepean Dyspepsia Index's responsiveness and develop a responsive, very short form. METHODS: A randomized, double-blind controlled trial was performed in 589 patients with documented functional dyspepsia. Symptoms and quality of life were measured at baseline, 2 and 4 weeks. Responsiveness of the Nepean Dyspepsia Index quality-of-life section was evaluated by correlation with symptom scores and calculation of standardized changes in scores. Two items from each sub-scale which best represented the area of life (by factor loadings) were selected to create the 10-item short form (SF; short form-Nepean Dyspepsia Index). Internal consistency was assessed by Cronbach's alpha and responsiveness was assessed as above. RESULTS: The Nepean Dyspepsia Index quality-of-life scales demonstrated excellent responsiveness to change in both the active and placebo arms (standardized response means all > 1.0). The Nepean Dyspepsia Index accounted for only 8% of the variance in percentage change in symptoms (by visual analogue scales), indicating that it was evaluating areas of life not covered by symptoms. The 10-item short form had adequate internal consistency (all scales > or = 0.70) and all strongly (and significantly) correlated with the long form sub-scales; it was also highly responsive. CONCLUSION: The Nepean Dyspepsia Index is a responsive disease-specific quality-of-life measure; the 10-item short form can be applied in clinical trials of functional dyspepsia.

Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebo-controlled trial.

INTRODUCTION: Motilin-receptor agonists are prokinetics; whether they relieve the symptoms of functional dyspepsia is unknown. We aimed to test the efficacy of the motilin agonist ABT-229 in functional dyspepsia patients with and without delayed gastric emptying. METHODS: Patients were randomized with postprandial symptoms and documented functional dyspepsia by endoscopy (n=589 in intention-to-treat analysis). Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated 13C octanoic acid breath test. Patients were then further randomized within each strata, to receive one of four doses of ABT-229 (1.25, 2. 5, 5 or 10 mg b.d. before breakfast and dinner) or placebo for 4 weeks, following a 2-week baseline. The primary outcome was the assessment of change in symptom severity over the 2 weeks from baseline to final visit, based on a self-report questionnaire measuring severity on visual analogue scales. RESULTS: Baseline characteristics across the treatment arms were very similar. No significant differences in the upper abdominal discomfort severity score (maximum 800 mm) were observed for any active treatment arm vs. placebo (mean change from baseline -139, -141, -145, -160 and -134 mm for placebo, 1.25, 2.5, 5, and 10 mg, respectively, at 4 weeks by intention-to-treat). More patients on placebo reported a good or excellent global response than patients on 1.25 or 5 mg of active therapy (both P < 0.05). The results were very similar in those with and without delayed gastric emptying. Helicobacter pylori status did not predict response. Excluding patients with any baseline heartburn (total remaining n=240), ABT-229 10 mg was inferior to placebo in relief of upper abdominal discomfort. CONCLUSIONS: ABT-229 was of no value for relief of symptoms in functional dyspepsia, compared with placebo.

Implications of an adjustable bed height during standard nursing tasks on spinal motion, perceived exertion and muscular activity.

Manual handling is a source of occupational stress, particularly for nursing personnel. High levels of biomechanical strain are associated with lifting and transferring patients, especially when the tasks are performed in flexed and twisted positions that induce an increased risk of functional and musculoskeletal problems. The use of adjustable beds in nursing practice has been suggested as a means of influencing working postures and reducing the muscular demands on nurses. The purpose of this study was to investigate the effects on spinal motion, muscular activity and perceived exertion when nurses had the opportunity to adjust bed height. The measures recorded during the conduct of standardized patient handling tasks were the changes in posture (inclination) and in shape (sagittal bending, side bending, axial rotation). Muscular activity was measured using surface electromyography. Perceived exertion was rated using the 15-graded Borg scale. The range of motion was not influenced by the adjustment of bed height, but rather a shift of the time duration histogram was noticed in the direction of the erect, safer position. The time spent in the safe zone of spinal motion near the erect position was significantly increased and was significantly decreased in the potential health-hazardous zones of spinal motion in the extreme positions. No differences in muscular activity or in perceived exertion were found between the two bed height conditions for any of the muscle groups. It was concluded that the quality of spinal motion is enhanced when the opportunity of adjusting the bed height is offered.

Will the use of different prevalence rates influence the development of a primary prevention programme for low-back problems?

To determine relations to low-back problems (LBP), different prevalence rates are used. The disadvantage of using different selection criteria is that studies are not comparable, except where they provide the same results. The present aim was to establish whether different prevalence selection criteria lead to different answers on a newly formed set of questionnaires. Since this set is new, reliability tests were performed (test-retest and calculations of Cronbach's Alpha, Cohen's Kappa and the intraclass correlation). Results of the questionnaire should form the cornerstones of a primary prevention programme. Altogether 1783 nurses in four Flemish (Belgian) hospitals were questioned. Information was gathered on work circumstances, education, general health, psychosocial factors, leisure activities, family situation and musculoskeletal problems. Four different datasets with variables related to lifetime prevalence LBP, annual prevalence LBP, point prevalence LBP and a set with all related variables were constructed. The variables demonstrating a relation with LBP differed slightly depending on the kind of prevalence used (lifetime, annual, point). A factor analysis on each set of prevalence related data failed due to the lack of homogeneity of the variables. Fear avoidance, coping aspects and musculoskeletal problems in other regions then the lower back were, in all circumstances, the most discriminating variables. Their discriminating power, however, differed depending on the kind of prevalence used. The differences were too small to influence the construction of the prevention programme. It is concluded that in developing a primary prevention programme any of the prevalence rates can be used. The combination of the three types of prevalence rates studied provides the most complete and reliable image.