Exploring the impact of high-energy diets on cattle: Insights into subacute rumen acidosis, insulin resistance, and hoof health.

Cattle lameness remains a significant concern, causing economic losses and compromising animal welfare. Claw horn lesions have been identified as a major cause of lameness in dairy cows, but their correlation with high-energy diets and ruminal acidosis remains unclear. Hence, the primary objective of this study was to assess the effects of a high-starch diet and a conventional diet on the rumen environment, acute-phase proteins, and metabolic alterations, with a particular focus on insulin resistance and the consequent implications for the histology of the hooves in Holstein steers. A total of 16 animals were divided into the high-starch (HS; 37% starch) and conventional (CON; 16.8% starch) groups. Glucose tolerance tests (GTT), blood analyses, rumen fluid analyses, and histological evaluations of the hoof tissue were conducted over a 102-d experimental period. The HS group showed a lower ruminal pH than the CON group, and with values indicating SARA. The plasma glucose and IGF-1 concentrations were higher in the HS group, suggesting an anabolic state. Both groups exhibited an increase in the insulin area under the curve (AUC) after the GTT on d 102. Histological analysis of the hooves showed a reduction in the length and width of the epidermal lamella in both groups. We found a significant negative correlation between the insulin AUC and the length and width of the epidermal lamella. Because both groups were similarly affected, the hypothesis that histological alterations were caused by the experimental diets still needs confirmation. Additionally, the development of SARA was not essential for the observed histological changes in the hoof. Further studies are warranted to thoroughly investigate the role of insulin and IGF-1 imbalances in claw health.

The effectiveness of faculty development programs for training university professors in the health area: a systematic review and meta-analysis.

BACKGROUND: The growing discussion on teacher development focuses on diversified educational skills that promote knowledge and innovation in the teaching, learning and assessment process. With the Covid-19 scenario, this picture of necessary changes has become more evident, demonstrating the need for professional preparation to work in teacher development. The aim of the study was to analyze the effectiveness of teacher development programs for the training of university teachers in the health area, through a systematic review and meta-analysis. METHODS: The systematic review and meta-analysis were carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved searching five databases - PubMed-Medline, Education Resource Information Center (ERIC), SCOPUS, Embase and Web of Science. The review included randomized clinical trials and cohort studies that addressed the effectiveness of teaching professionalization in the health area for university professors. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain the distribution of effects between the studies, using Stata® software (version 11.0) and publication bias was examined by visual inspection of the graphs and Egger's test. RESULTS: We included 12 studies in the systematic review and 8 in the meta-analysis. These studies were published between 1984 and 2022 in 14 countries. Significant changes were reported in teachers' behavior to stimulate and encourage students, improvement in the quality of teaching and teaching staff, as well as improvement in skills such as leadership and self-evaluation. Furthermore, the result of the meta-analysis showed that there is evidence of the effectiveness of the positive effects of teacher development programs after their implementation, with this effect being 1.70% and an increase of 4.75 in the effect of these teacher development programs. CONCLUSION: Our study shows that development programs have been implemented in different countries and contexts, all of which have proven to be effective in the short, medium and long term. We recommend that future research focus specifically on the different competencies that have been acquired following the implementation of these programs.

Unexpected positive cultures in patients with arthrofibrosis following total hip and total knee arthroplasty.

PURPOSE: It has been suggested that low-grade infections could be the cause of arthrofibrosis. However, this hypothesis has not been conclusively proven. The aim of this study is to assess the incidence of unexpected positive cultures (UPC) in patients undergoing revision total joint arthroplasty for a diagnosis of arthrofibrosis. METHODS: A retrospective single-centre review was performed. All patients who underwent an aseptic revision due to histologically confirmed arthrofibrosis (based on the synovial-like interface membrane (SLIM) criteria) were included. The incidence of UPC was then calculated. RESULTS: A total of 147 patients were included. Of these, 100 underwent a total knee arthroplasty (TKA) procedure and 46 a total hip arthroplasty (THA) surgery. One patient had a periprosthetic joint infection and was therefore excluded. Of the 146 included patients, 6 had confirmed UPC (4.08%). The following bacteria were identified: Anaerococcus octavius, Staphylococcus epidermidis, Enterobacter cloacae, Staphylococcus hominis, Streptococcus pluranimalium, Staphylococcus pettenkoferi. CONCLUSIONS: Our results suggest that the incidence of UPC in patients with arthrofibrosis is low. It is lower than that of UPC in patients that undergo a revision for other causes. There is no proven relationship between histologically confirmed arthrofibrosis following total joint arthroplasty and prosthetic joint infection.

Unexpected positive cultures in revision total knee arthroplasty after unicompartmental knee arthroplasty.

PURPOSE: Unexpected positive cultures are defined as a single positive culture in intraoperative samples taken during revision surgery after prosthetic joint infection was preoperatively ruled out. This study aims to determine the prevalence of unexpected positive cultures (UPC) in revision total knee arthroplasty (TKA) after unicompartmental knee arthroplasty (UKA). As a secondary objective, this study aims to compare the re-intervention rate in this specific group, between UPC and non-UPC patients. The hypothesis is that the UPC prevalence in patients who undergo a revision TKA after UKA is not higher than in other TKA revision cases and this does not increase the risk of re-intervention. METHODS: This is a retrospective study where all patients who underwent a UKA revision from January 2016 to February 2023 in a high-volume arthroplasty centre, were analyzed. Unexpected positive culture prevalence in this group of patients was obtained. RESULTS: During the included period, 270 UKA revision surgeries were performed. Eight cases had at least two positive cultures and were therefore excluded. The final analysis included 262 patients. Of these, 8 (3.05%) patients presented UPCs and the isolated microorganisms were low-virulence organisms. None of the UPC patients received any treatment. No statistical differences were found between UPC and non-UPC groups in the analyzed variables. CONCLUSION: The prevalence of unexpected positive cultures in patients following revision of unicompartmental knee arthroplasty is lower than in patients who undergo a revision of total knee arthroplasty. In UKA patients a UPC does not seem to increase the risk of a re-intervention, so it can be safely ignored if ICM criteria are not met.

The effectiveness of mobile application for monitoring diabetes mellitus and hypertension in the adult and elderly population: systematic review and meta-analysis.

CONTEXT: Arterial Hypertension (AH) and Diabetes Mellitus (DM) are diseases that are getting worse all over the world. Linked to this advance, is the growing digital health market with numerous mobile health applications, which aim to help patients and professionals in the proper management of chronic diseases. The aim of this study was to analyze, through a systematic review and meta-analysis, the effectiveness of using mobile health applications in monitoring AH and/or DM in the adult and elderly population. METHODS: The systematic review and meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Metanalyses guidelines and involved searching five databases - Medline/PubMed, Embase, CINAHL, Virtual Library in Health and Cochrane Library. The review included randomized and cohort clinical trials testing the effects of the intervention on changing biochemical parameters and clinical efficacy in people treated for AH and/or DM. The quality of the selected studies was assessed based on the evaluation criteria of the Joanna Briggs Institute tool. The random effects meta-analysis method was used to explain effect distribution between studies, by Stata® software (version 11.0) and publication bias was examined by visual inspection of graphs and Egger test. RESULTS: We included 26 studies in the systematic review and 17 in the meta-analysis. These studies were published between 2014 to 2022 in 14 countries. Were reported improvement in knowledge and self-management of AH and DM, social motivation with treatment and behavioral change, reduction in glycated hemoglobin values, fasting glucose and blood pressure, improvement in adherence to drug treatment, among others. The result of the meta-analysis showed that there is evidence that the use of mobile applications can help reduce glycated hemoglobin by 0.39% compared to the usual care group. CONCLUSIONS: Monitoring and self-monitoring of behaviors and health care related to AH and DM in adults and the elderly through mobile applications, has clinically significant effectiveness in reducing glycated hemoglobin levels. Future studies should provide more evidence and recommendations for best practices and development of digital health interventions. TRIAL REGISTRATION: PROSPERO. International Prospective Registry of Systematic Reviews. CRD42022361928.

Low-grade albuminuria and its relationship with cardiovascular disease risk in hypertensive and diabetic patients in primary health care.

OBJECTIVE: To evaluate the presence of LGA and the relationship with the 10-year risk of a cardiovascular event in hypertensive and diabetic patients in Primary Health Care. STUDY DESIGN: The study design used is cross-sectional. METHODS: This study was based on the application of questionnaires, anthropometric measurements, and laboratory tests carried out from August 2017 to April 2018. Logistic regression was used to evaluate the odds ratio of the explanatory variables in relation to the highest tercile of LGA. The Framingham risk score was used to assess the 10-year risk of cardiovascular event. The comparison of this score with the LGA terciles was analyzed using ANOVA. RESULTS: An increase in the 10-year risk of cardiovascular event score was observed with an increasing LGA tercile, and this pattern prevailed after adjusting for confounding variables. CONCLUSION: An association between LGA and the 10-year risk of cardiovascular event was observed in a representative sample of hypertensive and diabetic patients.

Blood Pressure After Endovascular Thrombectomy: Modeling for Outcomes Based on Recanalization Status.

Background and Purpose- The optimal level for blood pressure after endovascular thrombectomy in acute ischemic stroke is not well established. We sought to evaluate the association of post-endovascular thrombectomy systolic blood pressure (SBP) levels with clinical outcomes. Methods- We included endovascular thrombectomy-treated patients registered from 2014 to 2017 in the Safe Implementation of Treatments in Stroke International Thrombectomy Registry. The mean 24-hour SBP after endovascular thrombectomy treatment was analyzed both as a continuous variable and in intervals. The primary outcome was 3-month functional independence (modified Rankin Scale score of 0-2). The secondary outcomes were symptomatic intracerebral hemorrhage (SICH) and 3-month mortality. The SBP interval with the highest proportion of functional independence was chosen as reference. All analyses were performed for successful or unsuccessful recanalization (modified Treatment in Cerebral Ischemia score ≥2b or <2b, respectively). The results were adjusted for known confounders in logistic regression models. Results- In the multivariable analyses, a higher SBP value as a continuous variable was associated unfavorably with all outcomes in patients with successful recanalization (n=2920) and with more SICH in patients with unsuccessful recanalization (n=711). SBP interval ≥160 mm Hg was associated with less functional independence (adjusted odds ratio, 0.28 [95% CIs, 0.15-0.53]) and more SICH (adjusted odds ratio, 6.82 [95% CIs, 1.53-38.09]) compared with reference 100 to 119 mm Hg in patients with successful recanalization. SBP ≥160 mm Hg was associated with more SICH (adjusted odds ratio, 6.62 [95% CIs, 1.07-51.05]) compared with reference 120 to 139 mm Hg in patients with unsuccessful recanalization. Conclusions- Higher SBP values were associated with less functional independence at 3 months in patients with successful recanalization and with more SICH regardless of recanalization status.

Characteristics and Outcomes in Patients With COVID-19 and Acute Ischemic Stroke: The Global COVID-19 Stroke Registry.

Recent case-series of small size implied a pathophysiological association between coronavirus disease 2019 (COVID-19) and severe large-vessel acute ischemic stroke. Given that severe strokes are typically associated with poor prognosis and can be very efficiently treated with recanalization techniques, confirmation of this putative association is urgently warranted in a large representative patient cohort to alert stroke clinicians, and inform pre- and in-hospital acute stroke patient pathways. We pooled all consecutive patients hospitalized with laboratory-confirmed COVID-19 and acute ischemic stroke in 28 sites from 16 countries. To assess whether stroke severity and outcomes (assessed at discharge or at the latest assessment for those patients still hospitalized) in patients with acute ischemic stroke are different between patients with COVID-19 and non-COVID-19, we performed 1:1 propensity score matching analyses of our COVID-19 patients with non-COVID-19 patients registered in the Acute Stroke Registry and Analysis of Lausanne Registry between 2003 and 2019. Between January 27, 2020, and May 19, 2020, 174 patients (median age 71.2 years; 37.9% females) with COVID-19 and acute ischemic stroke were hospitalized (median of 12 patients per site). The median National Institutes of Health Stroke Scale was 10 (interquartile range [IQR], 4-18). In the 1:1 matched sample of 336 patients with COVID-19 and non-COVID-19, the median National Institutes of Health Stroke Scale was higher in patients with COVID-19 (10 [IQR, 4-18] versus 6 [IQR, 3-14]), P=0.03; (odds ratio, 1.69 [95% CI, 1.08-2.65] for higher National Institutes of Health Stroke Scale score). There were 48 (27.6%) deaths, of which 22 were attributed to COVID-19 and 26 to stroke. Among 96 survivors with available information about disability status, 49 (51%) had severe disability at discharge. In the propensity score-matched population (n=330), patients with COVID-19 had higher risk for severe disability (median mRS 4 [IQR, 2-6] versus 2 [IQR, 1-4], P<0.001) and death (odds ratio, 4.3 [95% CI, 2.22-8.30]) compared with patients without COVID-19. Our findings suggest that COVID-19 associated ischemic strokes are more severe with worse functional outcome and higher mortality than non-COVID-19 ischemic strokes.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort.

BACKGROUND: optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority. METHODS: we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox's proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values. RESULTS: Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39-5.12), serum iron (HR = 8.396, 95% CI: 2.02-34.96), serum calcium (HR = 4.102, 95% CI: 1.35-12.46) and serum protein (HR = 4.630, 95% CI: 2.07-10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01-0.74), high ferritin values (HR = 0.392, 95% CI: 0.19-0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19-0.61) and serum albumin (HR = 0.230, 95% CI: 0.10-0.54) were less risk to die. CONCLUSION: survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Multilevel analysis of factors that influence overweight in children: research in schools enrolled in northern Brazil School Health Program.

BACKGROUND: The study evaluates children in schools that participate in the School Health Program in the Northern region of Brazil with the objective of assessing whether their schools interfered in the development of overweight/obesity and how individual and school environment variables behave according to contextual analysis. METHODS: The analyses were carried out with 1036 children from 25 municipal public schools in Northern Brazil that participated in the School Health Program. We evaluated both individual characteristics and scholar environment through univariate and multivariate logistic regressions to identify which of these factors were related to overweight/obesity as well as the effect of varying such associations. RESULTS: The considered individuals had an median age of 8 years, being 54.9% female and 27.8% presenting overweight/obesity. In multivariate logistic regression, the overweight/obesity variance in schools was 0.386 (individual variables) and 0.102 (individual and school variables), explaining 23.7% of the variation, reduction of ICC and MOR. The Akaike Information Criterion between the models was reduced and the likelihood ratio indicated better adequacy of the latter model. The investigated children had a greater chance of developing overweight/obesity when they performed 2+ sedentary activities/day, depending on school location as well as whether or not candies were sold in the school surroundings. On the other hand, a lower chance of developing overweight/obesity was identified in children that ate 5+ meals/day and practiced dance at school. CONCLUSION: We observed that the variables inherent to both individuals and schools favored the development of overweight/obesity in children. It is relevant that scholar curriculums incorporate healthy eating interventions and encourage body practices associated with policies that restrain the sale of ultra-processed food in schools as well as the development of intersectoral actions between education and health to control childhood obesity.

From quantified to qualculated age: the health pragmatics of biological age measurement.

There is growing interest, within the social sciences, in understanding self-quantification and how it affects health practices in contemporary society. There is, however, less research on how ageing and health measurement relate, even though this relationship has become more pertinent with the growing availability of services and devices offering biological, personalised age measurements, from simple online questionnaires to telomere length quantification. Little is known about who uses these devices, why they use them and the socio-technical implications of such uses. To explore these issues, we conducted semi-structured interviews and focus groups with users of measurements of biological age (BA) in Denmark. We found that participants engage with the measurements with a degree of scepticism regarding their technical validity, reliability and sensitivity. Rather than seeking an exact biological quantification, participants use measurements as a pragmatic, rough indication of individual health. We develop a conceptual model to understand participants' engagement with BA measurements, which suggests that, instead of a substitution of chronological age for BA, users gauge the difference between the two to qualify their present and future individual trajectory in a lay model of the relationship between functional capacity and age.

Risk factors associated with lameness and hoof lesions in pasture-based dairy cattle systems in southeast Brazil.

Cattle lameness is an important welfare concern that also has an economic impact on the dairy industry. It can be a significant problem among pasture-based herds. Our objectives were to identify cow- and herd-level factors related to lameness and hoof lesions in dairy cows grazing year-round in Minas Gerais, Brazil. We performed a cross-sectional study in 48 pasture-based dairy herds, visiting each farm in a single visit. We evaluated 2,262 cows for mobility score (0-3) and 392 cows for hoof lesions. We used a questionnaire and checklist to capture herd management data. All information obtained was used to build multivariable models. The factors associated with lameness were low body condition score, longer time spent in the corral, being kept in paddocks during the drought period, and poor hygiene. For hoof lesions, track features were the most significant factor in determining the likelihood of heel horn erosion, white line fissure, and sole hemorrhage-by more than 3 times. Different factors related to unhygienic conditions such as leg cleanliness, frequency of cleaning, and longer time spent in the corral were associated with infectious hoof lesions. Poor human-animal relationship was related to sole hemorrhage, but patient handling of cows on the track was a protective factor against interdigital hyperplasia. The results of this study suggest that improving hygiene conditions, track features, and cow handling can improve dairy cattle mobility scores in pasture-based farms under tropical conditions. These findings also represent a first step toward planning actions aimed at decreasing lameness and hoof lesions in the studied region.

[Prevalence of tuberculosis in incarcerated populations: systematic review and meta-analysisPrevalencia de tuberculosis en la población privada de libertad: revisión sistemática y metanálisis]. / Prevalência de tuberculose na população privada de liberdade: revisão sistemática e metanálise.

OBJECTIVE: To estimate the prevalence of tuberculosis among incarcerated populations. METHOD: A systematic review with meta-analysis was performed. The MEDLINE/PubMed, SciELO, and LILACS databases were searched for articles published from January 1997 to December 2016. The following search terms were used: ("tuberculosis"[MeSH] OR "tuberculosis"[TIAB]) AND ("prisons"[MeSH] OR "prisons"[TIAB]); or ("tuberculose" [DeCS] OU "tuberculose" [palavras] E "prisões" [DeCS] OU "prisões" [palavras]). The primary outcome was the prevalence of tuberculosis with 95% confidence interval (95%CI). In the metanalysis, variables associated with tuberculosis prevalence in incarcerated populations in the univariate analysis (P ≤ 0,20) were included in the final multivariate model. RESULTS: Based on the 29 studies included in the metanalysis, 2,163 prisoners with tuberculosis were identified. The combined prevalence of tuberculosis among prisoners was 2% (95%CI: 0.02-0.02). The prevalence among prisoners from countries with tuberculosis prevalence of 0-24 per 100,000 general population was below 1% (95%CI = 0.00-0.00). In countries with overall tuberculosis prevalence of 25-99/100,000, the estimate among prisoners was 3% (95%CI = 0.02-0.04); and in countries with overall prevalence ≥ 300/100 thousand, the estimated prevalence among prisoners was 8% (95%CI = 0.05-0.11). CONCLUSION: The present results support the notion of a high prevalence of tuberculosis among incarcerated populations worldwide. The results also show a link between the prevalence of tuberculosis in the general and the prevalence of tuberculosis in prisons.

OBJETIVO: Estimar la prevalencia de tuberculosis en la población privada de libertad. MÉTODOS: Se realizó una revisión sistemática con metanálisis. Se seleccionaron estudios publicados desde enero de 1997 hasta diciembre del 2016 en las bases de datos MEDLINE/PubMed, SciELO y LILACS. Los términos de búsqueda fueron ("tuberculosis"[MeSH] OR "tuberculosis"[TIAB]) AND ("prisons"[MeSH] OR "prisons"[TIAB]); o ("tuberculose" [DeCS] OU "tuberculose" [palavras] E "prisões" [DeCS] OU "prisões" [palavras]). El resultado principal fue la prevalencia de tuberculosis con un intervalo de confianza de 95% (IC95%). En el metanálisis, las variables asociadas con la prevalencia de la tuberculosis en la población privada de libertad en el análisis univariado (P ≤ 0,20) se incluyeron en el modelo final multivariado. RESULTADOS: Con base en los 29 estudios incluidos en el metanálisis, se detectaron 2 163 presos con tuberculosis. La prevalencia combinada de tuberculosis en los presos fue de 2% (IC95%: 0,02-0,02). La prevalencia de tuberculosis en presos de los países con prevalencia de 0 a 24 por 100.000 habitantes en la población general fue inferior a 1% (IC95% = 0,00-0,00). En los países con una prevalencia de tuberculosis de 25 a 99 por 100.000, la estimación fue de 3% (IC95% = 0,02-0,04); y en los países con prevalencia ≥ 300 por 100.000, de 8% (IC95% = 0,05-0,11). CONCLUSIÓN: El presente estudio reafirma la alta prevalencia de la tuberculosis en la población privada de libertad en el contexto mundial. Los resultados muestran además una conexión entre la prevalencia de la tuberculosis en la población general y la observada dentro de los presidios.

Devicing future populations: Problematizing the relationship between quantity and quality of life.

Taking as point of departure the claim that, in late modern societies, there has been shift from a focus on producing measures of life and death towards metrics of health and disability, this paper investigates how, through what means and processes was this transition achieved. It proposes that such questions can be addressed by analysing the transcripts and sociotechnical network of a meeting held at the United States Senate on July 15th 1983 to assess the validity and sensitivity of life expectancy forecasts. The paper analyses how members of the Hearing transformed a weakly articulated set of differing life expectancy projections into a controversy about the issue of vitality and health in populations. Analysis of the Hearing proceedings suggests that 'calculative devices' played a generative role in problematizing the relationship between forms of expertise, calculative procedures, data infrastructures and specific expectations of the effect of technology on health and longevity. The paper details empirically that this re-composition was possible through a collective investigation - an opening up - of key instruments in the management of populations in 'insurance societies'.

Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis: Results From the SITS-ISTR.

BACKGROUND AND PURPOSE: Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes. METHODS: We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months. RESULTS: In hospitals performing any TCD pre-IVT, 1701 of 11 265 patients (15%) had TCD before IVT initiation. Door-to-needle time was higher in patients with pre-IVT TCD (74 versus 60 minutes; P<0.001). At hospitals performing any TCD during IVT infusion, of 9044 patients with IVT, 747 were examined with TCD during IVT. No treatment delay was seen with TCD during IVT. After multivariate adjustment, TCD during IVT was independently associated with modestly increased excellent functional outcome (modified Rankin Scale, 0-1; adjusted odds ratio, 1.28; 95% confidence interval, 1.06-1.55; P=0.012) and lower mortality (adjusted odds ratio, 0.73; 95% confidence interval, 0.55-0.95; P=0.022). CONCLUSIONS: We recommend that TCD, if performed, should be done during IVT infusion, to avoid treatment delay. The association of hyperacute TCD with beneficial outcomes suggests potential impact on patient management, which warrants further study.

Prevalence of lameness and hoof lesions in all year-round grazing cattle in Brazil.

Lameness is a growing concern to the dairy industry worldwide. However, little is known about lameness and its causes in grazing cattle, especially in tropical climates. This study aimed to assess the prevalence of hoof lesions and lameness in dairy herds of all year-round grazing cattle under tropical condition, and to identify the main lesions associated with lameness. We visited 48 farms located in the Minas Gerais state, Brazil, equally divided into four groups based on daily milk production. All lactating cows in the visited farms were locomotion scored, and a representative sample was randomly chosen for hoof inspection. Among the 2267 lactating cows evaluated, 16% were scored as lame and 7% as severely lame. Nearly all cows presented at least one type of hoof lesion, of which heel horn erosion (90%), white line fissure (50%), and digital dermatitis (33%) were the most prevalent. Heel horn erosion was present in all farms and digital dermatitis was present in 96% of the farms. Sole ulcer was observed in a single animal. Additionally, digital dermatitis and white line fissure were correlated to a 2.5 times increase in the odds of a poor mobility score. Collectively, our results demonstrate that digital dermatitis and white line fissure are the main concern and the biggest cause of lameness in grazing cattle under tropical conditions.

Factors related to the self-application of insulin in subjects with diabetes mellitus. / Fatores relacionados à autoaplicação de insulina em indivíduos com diabetes mellitus.

OBJECTIVE: To identify the factors associated with the self-application of insulin in adult individuals with Diabetes Mellitus. METHOD: A cross-sectional study developed in the city of Viçosa-MG, which assessed 142 patients. The data collection was performed between April and July 2013 through an interview at the participant's home. Multiple logistic regression was used. RESULTS: The prevalence of the self-administration of insulin was of 67.6%, and it was associated with ages between 57 and 68 years old (OR = 0.3, 95% CI: 0.1-0.9), living with a partner and children (OR = 2.5, 95% CI: 1.1-5.0), 9 years or more of study (OR = 8.4, 95% CI: 1.9-37.9), living in an area not covered by the Family Health Strategy (FHS) (OR = 2.8, 95% CI: 1.1 - 7.0). CONCLUSION: The self-application of insulin was associated with age, schooling, marital status, and the FHS coverage. The recognition of these factors may contribute to the adherence to the self-application of insulin.

Applying openEHR's Guideline Definition Language to the SITS international stroke treatment registry: a European retrospective observational study.

BACKGROUND: Interoperability standards intend to standardise health information, clinical practice guidelines intend to standardise care procedures, and patient data registries are vital for monitoring quality of care and for clinical research. This study combines all three: it uses interoperability specifications to model guideline knowledge and applies the result to registry data. METHODS: We applied the openEHR Guideline Definition Language (GDL) to data from 18,400 European patients in the Safe Implementation of Treatments in Stroke (SITS) registry to retrospectively check their compliance with European recommendations for acute stroke treatment. RESULTS: Comparing compliance rates obtained with GDL to those obtained by conventional statistical data analysis yielded a complete match, suggesting that GDL technology is reliable for guideline compliance checking. CONCLUSIONS: The successful application of a standard guideline formalism to a large patient registry dataset is an important step toward widespread implementation of computer-interpretable guidelines in clinical practice and registry-based research. Application of the methodology gave important results on the evolution of stroke care in Europe, important both for quality of care monitoring and clinical research.

Understanding the role of patient organizations in health technology assessment.

BACKGROUND: The involvement of patient representatives in health technology assessment is increasingly seen by policy makers and researchers as key for the deployment of patient-centred health care, but there is uncertainty and a lack of theoretical understanding regarding the knowledge and expertise brought by patient representatives and organisations to HTA processes. OBJECTIVE: To propose a conceptually-robust typological model of the knowledge and expertise held by patient organisations. DESIGN, DATA COLLECTION AND ANALYSIS: The study followed a case-study design. Data were collected within an international research project on patient organisations' engagement with knowledge, and included archival and documentary data, in-depth interviews with key members of the organisation and participant observation. Data analysis followed standard procedure of qualitative analysis anchored in an analytic induction approach. RESULTS: Analysis identified three stages in the history of the patient organisation under analysis - Alzheimer's Society. In a first period, the focus is on 'caring knowledge' and an emphasis on its volunteer membership. In a transition stage, a combination of experiential, clinical and scientific knowledge is proposed in an attempt to expand its field of activism into HTA. In the most recent phase, there is a deepening of its network of associations to secure its role in the production of evidence. CONCLUSIONS: Analysis identified an important relationship between the forms of knowledge deployed by patient organisations and the networks of expertise and policy they mobilise to pursue their activities. A model of this relationship is outlined, for the use of further research and practice on patient involvement.

Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR's Guideline Definition Language.

BACKGROUND: Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care. METHODS: We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases' compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data. RESULTS: We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results. CONCLUSIONS: Shareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown.