Pilot implementation of MiLES: a web-based intervention targeted at managers with the aim of enhancing the successful return to work of employees with cancer.

BACKGROUND: MiLES is a web-based intervention targeted at managers with the aim of enhancing the successful return to work (RTW) of employees with cancer. The purpose of this study was to identify barriers to and facilitators of implementing MiLES in organizations, from a manager's perspective. MATERIAL AND METHODS: MiLES was implemented as a pilot in four organizations for six weeks. Sixteen managers were included, of which fourteen were interviewed regarding their perceived barriers to and facilitators of implementation of MiLES in their organization. Interviews were recorded, transcribed verbatim and analyzed with content analysis. RESULTS: The managers experienced barriers to and facilitators of implementation related to: (1) implementation responsibilities, (2) the intervention's content, and (3) organizational characteristics. Regarding implementation responsibilities, management board approval and an organizational infrastructure with distinct described implementation responsibilities were perceived as facilitators. Regarding the intervention's content, its accessibility, user-friendliness and completeness were perceived as facilitators. If the content did not meet the manager's specific needs, this was perceived as a barrier. Regarding organizational characteristics, several intangible (e.g., added value of MiLES within different organizations) and tangible (e.g., integration into absenteeism registration) organizational characteristics were perceived as facilitators. The absence of a quiet place to use MiLES was perceived as barrier. CONCLUSION: Implementation of MiLES in organizations may benefit from an infrastructure within the organization that defines responsibilities regarding intervention delivery to managers of employees with cancer. Such an infrastructure should be aligned to existing organizational structures. As per interviewed managers, MiLES has added value in diverse organizations.

Identification of actions to be taken by managers to facilitate the return to work of cancer survivors: Consensus between managers and cancer survivors.

BACKGROUND: Managers are considered to be main stakeholders in the return to work (RTW) of cancer survivors. However, the perspectives of cancer survivors and managers differ on what managerial actions should be taken during the RTW of cancer survivors. This difference might put effective collaboration and successful RTW at risk. Therefore, this study aims to reach consensus among managers and cancer survivors on the managerial actions to be taken during the four different RTW phases of cancer survivors (i.e., Disclosure, Treatment, RTW plan, Actual RTW). METHODS: The Technique for Research of Information by Animation of a Group of Experts (TRIAGE) was implemented with managers and cancer survivors (hereafter referred to as "experts"). An initial list of 24 actions was derived from a previous study. Firstly, for each action, fifteen experts were asked to indicate individually how important this action is per RTW phase (Likert scale from 1 - "Not important at all" to 6 - "Very important"). Consensus was reached when ≥ 80% (i.e., ≥ twelve experts) of the experts rated that action ≥5. Secondly, for each phase of the RTW process, the 15 actions with the highest percentage were discussed with eight experts during the collective consultation, except for the actions that already reached consensus. After discussion, the experts voted whether each action was important ("yes" / "no") and consensus required ≥ 87.5% (i.e., ≥ seven experts) of the experts to consider an action as important. RESULTS: Twenty-five managerial actions were finally retained for at least one of the RTW phases, e.g., Disclosure: "respect privacy" and "radiate a positive attitude", Treatment: "show appreciation" and "allow sufficient sick leave", RTW Plan: "tailor" and "communicate", and Actual RTW: "support practically" and "balance interest". CONCLUSION: Cancer survivors and managers reached consensus on the importance of 25 managerial actions, distributed into each phase of the RTW process. These actions should be considered an interplay of managerial actions by different stakeholders on the part of the employer (e.g., direct supervisor, HR-manager), and should be a responsibility that is shared by these stakeholders. The collective implementation of these actions within the company will help cancer survivors feel fully supported.

A randomised feasibility trial of an employer-based intervention for enhancing successful return to work of cancer survivors (MiLES intervention).

BACKGROUND: Employers express a need for support during sickness absence and return to work (RTW) of cancer survivors. Therefore, a web-based intervention (MiLES) targeted at employers with the objective of enhancing cancer survivors' successful RTW has been developed. This study aimed to assess feasibility of a future definitive randomised controlled trial (RCT) on the effectiveness of the MiLES intervention. Also preliminary results on the effectiveness of the MiLES intervention were obtained. METHODS: A randomised feasibility trial of 6 months was undertaken with cancer survivors aged 18-63 years, diagnosed with cancer < 2 years earlier, currently in paid employment, and sick-listed < 1 year. Participants were randomised to an intervention group, with their employer receiving the MiLES intervention, or to a waiting-list control group (2:1). Feasibility of a future definitive RCT was determined on the basis of predefined criteria related to method and protocol-related uncertainties (e.g. reach, retention, appropriateness). The primary effect measure (i.e. successful RTW) and secondary effect measures (e.g. quality of working life) were assessed at baseline and 3 and 6 months thereafter. RESULTS: Thirty-five cancer survivors were included via medical specialists (4% of the initially invited group) and open invitations, and thereafter randomised to the intervention (n = 24) or control group (n = 11). Most participants were female (97%) with breast cancer (80%) and a permanent employment contract (94%). All predefined criteria for feasibility of a future definitive RCT were achieved, except that concerning the study's reach (90 participants). After 6 months, 92% of the intervention group and 100% of the control group returned to work (RR: 0.92, 95% CI: 0.81-1.03); no difference were found with regard to secondary effect measures. CONCLUSIONS: With the current design a future definitive RCT on the effectiveness of the MiLES intervention on successful RTW of cancer survivors is not feasible, since recruitment of survivors fell short of the predefined minimum for feasibility. There was selection bias towards survivors at low risk of adverse work outcomes, which reduced generalisability of the outcomes. An alternative study design is needed to study effectiveness of the MiLES intervention. TRIAL REGISTRATION: The study has been registered in the Dutch Trial Register ( NL6758/NTR7627 ).

The Use and Perceived Usefulness of an Online Toolbox Targeted at Employers (MiLES Intervention) for Enhancing Successful Return to Work of Cancer Survivors.

PURPOSE: The MiLES intervention is a web-based intervention targeted at employers with the objective of enhancing successful return to work (RTW) of cancer survivors. The aim of this study is to gain insight into the employers' use and perceived usefulness of the MiLES intervention. METHODS: Employer representatives (e.g. Human Resource managers and supervisors) were given access to the MiLES intervention, which contains, among others, interactive videos, conversation checklists and tailored tips. After six weeks, an online questionnaire gathered data on employers' use and the perceived usefulness of the intervention. In-depth qualitative data on these topics were gathered during semi-structured interviews, which were analyzed using a content analysis. RESULTS: Thirty-one eligible employers were included. Twenty-two of them filled out the questionnaire and twenty were interviewed. Typically, employers used the intervention 2-3 times, for 26 min per visit. The usefulness of the intervention scored 7.6 out of 10 points, and all employers would recommend it to colleagues. Employers' use decreased when support needs were low and when the intervention did not correspond with their specific situation (e.g. complex reintegration trajectories). Employers perceived the intervention to be supporting and practically oriented. They appreciated the fact that the intervention was web-based and combined visual and textual content. The possibility of consulting specialized services for complex situations would further enhance its usefulness. CONCLUSION: The MiLES intervention provides employers with a useful tool in their daily practice. Its effectiveness for enhancing employers' managerial skills and cancer survivors' successful RTW is subject for further research.

Return to work experiences of patients treated with stem cell transplantation for a hematologic malignancy.

PURPOSE: This qualitative study aimed to identify hematopoietic stem cell transplantation (HSCT) survivors' (1) work perceptions; (2) barriers to and facilitators of return to work (RTW); and (3) possible solutions to improve RTW. METHOD: Fifteen patients treated with HSCT 1-5 years ago participated in face-to-face semi-structured interviews. Interviews were analyzed following the steps of thematic content analyses. RESULTS: RTW was often characterized as a complex and prolonged trajectory, and it was frequently incomplete in working hours, tasks, and/or responsibilities. Work perceptions varied between patients; most valued work as positive, but some also reported a decline in work capacity and/or in importance. Perceived barriers included the duration and side effects of cancer treatment, the presence of comorbidity and poor health before diagnosis, having difficulties commuting and doing household tasks. Perceived facilitators were financial incentives, keeping in touch with the workplace, support of other patients and family, and looking after one's health. Proposed solutions to improve RTW included discussing RTW at the hospital, enhanced employer support, improved accessibility of rehabilitation programs, and more information about the consequences of being sick-listed. CONCLUSIONS: Many HSCT survivors value work as important and they are motivated to RTW. Insight in work perceptions, RTW barriers, and solutions might help researchers, healthcare professionals, and employers to develop and/or tailor individualized multidisciplinary care to facilitate RTW.

What Employer Actions Are Considered Most Important for the Return to Work of Employees with Cancer? A Delphi Study Among Employees and Employers.

Purpose Employers are important stakeholders in the return to work (RTW) of employees with cancer. However, it is unclear what employer actions are most important to that process. The objective, therefore, was to reach consensus on what employer actions are considered most important for the RTW of employees with cancer, by employers and employees separately. Methods A two-round online Delphi study was conducted with two expert panels: one with 23 employers and one with 29 employees with cancer. The results from each panel were analysed separately. Out of 24 suggested employer actions, participants selected the 10 they considered most important for RTW in each of the following RTW phases: (1) disclosure, (2) treatment, (3) RTW plan, and (4) actual RTW. The consensus threshold was set at ≥ 80% during the second round. Results The employer and employee expert panels both reached consensus on the importance of 'emotional support', 'practical support', 'allow sufficient sick leave', 'plan return to work', 'adjust expectations', 'assess work ability', and 'show appreciation'. Employers also reached consensus on 'communicate' and 'treat normally', and employees on 'handle unpredictability'. All these employer actions were considered to be specific for one to three RTW phases. Conclusions Employers reached consensus on the importance of nine employer actions, employees on eight. Both stakeholder perspectives showed great similarities, but did vary regarding important employer actions during the employee's treatment. We recommend developing interventions targeting the employer, meeting both employer and employee needs in each RTW phase, to enhance RTW support for employees with cancer.

Two-Year Follow-Up of a Multi-centre Randomized Controlled Trial to Study Effectiveness of a Hospital-Based Work Support Intervention for Cancer Patients.

Purpose Purpose is to: (1) study effectiveness of the hospital-based work support intervention for cancer patients at two years of follow-up compared to usual care and (2) identify which early factors predict time to return-to-work (RTW). Methods In this multi-center randomised controlled trial (RCT), 106 (self-)employed cancer patients were randomized to an intervention group or control group and provided 2 years of follow-up data. The intervention group received patient education and work-related support at the hospital. Primary outcome was RTW (rate and time) and quality of life (SF-36), and secondary outcomes were, work ability (WAI), and work functioning (WLQ). Univariate Cox regression analyses were performed to study which early factors predict time to full RTW. Results Participants were diagnosed with breast (61%), gynaecological cancer (35%), or other type of cancer (4%). RTW rates were 84% and 90% for intervention versus control group. They were high compared to national register-based studies. No differences between groups were found on any of the outcomes. Receiving chemotherapy (HR = 2.43, 95% CI 1.59-3.73 p < 0.001), low level of education (HR = 1.65, 95% CI 1.076-2.52 p = 0.02) and low work ability (HR = 1.09 [95% CI 1.04-1.17] p = 0.02) were associated with longer time to full RTW. Conclusions We found high RTW rates compared to national register-based studies and we found no differences between groups. Future studies should therefore focus on reaching the group at risk, which consist of patients who receive chemotherapy, have a low level of education and have a low work ability at diagnosis. TRIAL REGISTRATION: Netherlands Trial Registry (NTR) (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1658): NTR1658.

Perceived employer-related barriers and facilitators for work participation of cancer survivors: A systematic review of employers' and survivors' perspectives.

OBJECTIVE: To identify employer-related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences. METHODS: A systematic review of qualitative studies focusing on employers' and cancer survivors' perspectives on the work participation of cancer survivors was performed. Four databases (MEDLINE, EMBASE, PsycINFO, and Business Source Premier) were systematically searched, and the quality of studies included was assessed using the CASP checklist. Perceived barriers and facilitators were extracted and synthesised to conduct a content analysis. RESULTS: Five studies representing the employers' perspectives and 47 studies representing the cancer survivors' perspectives were included. Employers perceived barriers and facilitators related to support, communication, RTW policies, knowledge about cancer, balancing interests and roles, and attitude. Survivors perceived barriers and facilitators related to support, communication, work environment, discrimination, and perception of work ability. The synthesis found that the employers' willingness to support can be understood by perceptions they have of the survivor, goals of the employer, and national or organisational policies. Employers require knowledge about cancer and RTW policies to be able to support survivors. CONCLUSIONS: This review identified a plurality of and a large variety in perceived employer-related barriers and facilitators for work participation of cancer survivors, which can be understood to be related to both employers' willingness and ability to support. There is a need for interventions targeting employers, with the aim of enhancing the sustainable work participation of cancer survivors.

Employment and insurance outcomes and factors associated with employment among long-term thyroid cancer survivors: a population-based study from the PROFILES registry.

PURPOSE: To obtain insight into employment and insurance outcomes of thyroid cancer survivors and to examine the association between not having employment and other factors including quality of life. METHODS: In this cross-sectional population-based study, long-term thyroid cancer survivors from the Netherlands participated. Clinical data were collected from the cancer registry. Information on employment, insurance, socio-demographic characteristics, long-term side effects, and quality of life was collected with questionnaires. RESULTS: Of the 223 cancer survivors (response rate 87 %), 71 % were employed. Of the cancer survivors who tried to obtain insurance, 6 % reported problems with obtaining health care insurance, 62 % with life insurance, and 16 % with a mortgage. In a multivariate logistic regression analysis, higher age (OR 1.07, CI 1.02-1.11), higher level of fatigue (OR 1.07, CI 1.01-1.14), and lower educational level (OR 3.22, CI 1.46-7.09) were associated with not having employment. Employment was associated with higher quality of life. CONCLUSIONS: Many thyroid cancer survivors face problems when obtaining a life insurance, and older, fatigued, and lower educated thyroid cancer survivors may be at risk for not having employment.

A hospital-based work support intervention to enhance the return to work of cancer patients: a process evaluation.

PURPOSE: To perform a process evaluation of a hospital-based work support intervention for cancer patients aimed at enhancing return to work and quality of life. The intervention involves the delivery of patient education and support at the hospital and involves the improvement of the communication between the treating physician and the occupational physician. In addition, the research team asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. METHODS: Eligible were cancer patients treated with curative intent and who have paid work. Data were collected from patients assigned to the intervention group (N = 65) and from nurses who delivered the patient education and support at the hospital (N = 4) by means of questionnaires, nurses' reports, and checklists. Data were quantitatively and qualitatively analysed. RESULTS: A total of 47 % of all eligible patients participated. Nurses delivered the patient education and support in 85 % of the cases according to the protocol. In 100 % of the cases at least one letter was sent to the occupational physician. In 10 % of the cases the meeting with the patient, the occupational physician and the supervisor took place. Patients found the intervention in general very useful and nurses found the intervention feasible to deliver. CONCLUSIONS: We found that a hospital- based work support intervention was easily accepted in usual psycho-oncological care but that it proved difficult to involve the occupational physician. Patients were highly satisfied and nurses found the intervention feasible.

Return-to-work interventions integrated into cancer care: a systematic review.

OBJECTIVES: The purpose of this study was to review the literature on the content of interventions focusing on return to work, employment status, or work retention in patients with cancer. Furthermore, the effect of the interventions on return to work was assessed in studies reporting return to work. METHODS: A literature search was conducted using the databases MEDLINE, PsycINFO, EMBASE and CINAHL. Articles that described a work-directed intervention focusing on return to work, employment status, or work retention in patients with cancer were included. The content of the work-directed part of the interventions was assessed based on two criteria for content analysis: 1. does the setting fit the shared care model of cancer survivor care? 2. Does the intervention target work ability and physical workload? For studies reporting return-to-work outcomes, the return-to-work rates were assessed. For studies that used a control group the ORs and the 95% CIs were calculated. RESULTS: Twenty-three articles describing 19 interventions met the inclusion criteria. Seven studies reported return-to-work outcomes of which four used a control group. Only three interventions aimed primarily at enhancing return to work or employment status. The most frequently reported work-directed components were encouragement, education or advice about work or work-related subjects (68%), vocational or occupational training (21%), or work accommodations (11%). One intervention fit the shared care model of cancer survivor care and five interventions enhanced work ability or decreased physical workload. The rate of return to work ranged from 37% to 89%. In one of the four controlled studies the intervention increased return to work significantly and in the other studies the results were insignificant. CONCLUSIONS: Only few interventions are primarily aimed at enhancing return to work in patients with cancer and most do not fit the shared care model involving integrated cancer care. Future studies should be developed with well-structured work-directed components that should be evaluated in randomised controlled trials.

Introduction to special section on: current topics in cancer survivorship and work.

Work is a key contributor to quality of life and an important aspect of cancer survivorship. We call attention to current topics in cancer survivorship and work with 12 articles on cancer survivorship and work in this special section. The focus is on less studied diagnostic groups such as gastrointestinal cancer and prostate cancer, and on long-term effects of cancer diagnosis and treatment on work. Furthermore, studies are included on topics not generally studied including cognitive limitations and pain, the role of the employer on work outcomes among different types of cancer survivors and some countries not typically covered in the existing literature on work and cancer survivorship. We conclude that to improve sustainable work participation in cancer survivors, personalised, tailored interventions should be provided. A prerequisite for this is the identification of groups and individuals at high risk for adverse work outcomes. In order to develop such interventions, research involving new approaches such as matching data registries, participatory approaches and the involvement of many stakeholders and survivors with these different types of cancer diagnoses is necessary. IMPLICATIONS FOR CANCER SURVIVORS: The goal of sustainable work participation in cancer survivors can be improved by the delivery of a personalised or risk-based tailored intervention. Furthermore, successful work outcomes often involve many stakeholders who should all be included Implications for Cancer Survivors. The goal of sustainable work participation in cancer survivors can be improved by the delivery of a personalised or risk-based tailored intervention. Furthermore, successful work outcomes often involve many stakeholders who should all be included.

Supporting employers to enhance the return to work of cancer survivors: development of a web-based intervention (MiLES intervention).

PURPOSE: The purpose of this study was to develop an intervention targeting employers, with the aim of enhancing cancer survivors' return to work (RTW). METHODS: Intervention Mapping was used to combine information gathered from several procedures involving numerous stakeholders, for example, employers, cancer survivors, oncological occupational physicians, and e-health experts. RESULTS: Employers indicated that they require tailored support during four RTW phases: (1) disclosure, (2) treatment, (3) RTW planning, and (4) actual RTW. The most important employer actions were identified for each RTW phase, for instance, "communicate," "support practically," and "assess work ability," and thereafter formulated as the performance objectives of the intervention. The trans-theoretical model of change was used as a theoretical framework, and several methodologies were employed to induce the desired behavior change, for example modeling, tailoring, and active learning. Subsequently, a web-based intervention with interactive videos, conversation checklists, links to reliable external sources, and succinct, tailored tips and information was developed and adjusted on the basis of pre-tests with different stakeholders. CONCLUSIONS: The intervention was developed with input from employers and all relevant stakeholders in the RTW of cancer survivors. The systematic, step-wise development resulted in a succinct and easily accessible intervention targeting the most important employer actions during all RTW phases. As such, the intervention corresponds with employers' needs and preferences in practice. IMPLICATIONS FOR CANCER SURVIVORS: By providing employers with support, the intervention could well be the missing link in efforts to optimize the work participation of cancer survivors.

Effect of timing of corn silage supplementation to Holstein dairy cows given limited daily access to pasture: intake and performance.

The timing in which supplements are provided in grazing systems can affect dry matter (DM) intake and productive performance. The objective of this study was to evaluate the effect of timing of corn silage supplementation on ingestive behaviour, DM intake, milk yield and composition in grazing dairy cows. In total, 33 Holstein dairy cows in a randomized block design grazed on a second-year mixed grass-legume pasture from 0900 to 1500 h and received 2.7 kg of a commercial supplement at each milking. Paddock sizes were adjusted to provide a daily herbage allowance of 15 kg DM/cow determined at ground level. The three treatments imposed each provided 3.8 kg DM/day of corn silage offered in a single meal at 0800 h (Treatment AM), equally distributed in two meals 0800 and 1700 h (Treatment AM-PM) or a single meal at 1700 h (Treatment PM). The experiment was carried out during the late autumn and early winter period, with 1 week of adaptation and 6 weeks of measurements. There were no differences between treatments in milk yield, but 4% fat-corrected milk yield tended to be greater in AM-PM than in AM cows, which did not differ from PM (23.7, 25.3 and 24.6±0.84 kg/day for AM, AM-PM and PM, respectively). Fat percentage and yield were greater for AM-PM than for AM cows and intermediate for PM cows (3.89 v. 3.66±0.072% and 1.00 v. 0.92±0.035 kg/day, respectively). Offering corn silage in two meals had an effect on herbage DM intake which was greater for AM-PM than AM cows and was intermediate in PM cows (8.5, 11.0 and 10.3±0.68 kg/day for AM, AM-PM and PM, respectively). During the 6-h period at pasture, the overall proportion of observations on which cows were grazing tended to be different between treatments and a clear grazing pattern along the grazing session (1-h observation period) was identified. During the time at pasture, the proportion of observations during which cows ruminated was positively correlated with the DM intake of corn silage immediately before turn out to pasture. The treatment effects on herbage DM intake did not sufficiently explain differences in productive performance. This suggests that the timing of the corn silage supplementation affected rumen kinetics and likewise the appearance of hunger and satiety signals as indicated by observed changes in temporal patterns of grazing and ruminating activities.

The effect of silage and concentrate type on intake behavior, rumen function, and milk production in dairy cows in early and late lactation.

The objective of this experiment was to evaluate the effect of feeding total mixed rations (TMR) that differ in structural and nonstructural carbohydrates to dairy cows in early and late lactation on short-term feed intake, dry matter intake (DMI), rumen fermentation variables, and milk yield. A 5 x 5 Latin square experiment with 15 dairy cows was repeated during early and late lactation. The 5 treatments were a TMR with (all on dry matter basis) 55% roughage (a 50:50 mixture of corn silage and grass silage) and 45% concentrate (a 50:50 mixture of concentrate rich in structural carbohydrates and concentrate rich in nonstructural carbohydrates; treatment CON), a TMR with the concentrate mixture and 55% grass silage (RGS) or 55% corn silage (RCS), and a TMR with the roughage mixture and 45% of the concentrate rich in structural carbohydrates (CSC) or the concentrate rich in nonstructural carbohydrates (CNS). Meal criteria, determined using the Gaussian-Gaussian-Weibull method per animal per treatment, showed an interaction between lactation stage and treatment. Feed intake behavior variables were therefore calculated with meal criteria per treatment-lactation stage combination. Differences in feed intake behavior were more pronounced between treatments differing in roughage composition than between treatments differing in concentrate composition, probably related to larger differences in chemical composition and particle size between corn silage and grass silage than between the 2 concentrates. The number of meals was similar between treatments, but eating time was greater in RGS (227 min/d) and lesser in RCS (177 min/d) than the other treatments. Intake rate increased when the amount of grass silage decreased, whereas meal duration decreased simultaneously. These effects were in line with a decreased DMI of the RGS diet vs. the other treatments, probably related to the high neutral detergent fiber (NDF) content. However, this effect was not found in CSC, although NDF content of the TMR, fractional clearance rate of NDF, and fractional degradation rate of NDF was similar between CSC and RGS. Rumen fluid pH was lesser, and molar proportions of acetic acid and of propionic acid were lesser and greater, respectively, in RCS compared with all other diets. Milk production did not differ between treatments. There was no effect of type of concentrate on milk composition, but diet RCS resulted in a lesser milk fat content and greater milk protein content than diet RGS. Lactation stage did affect short-term feed intake behavior and DMI, although different grass silages were fed during early and late lactation. The results indicate that short-term feed intake behavior is related to DMI and therefore may be a helpful tool in optimizing DMI and milk production in high-production dairy cows.

Frequent allocation of rotationally grazed dairy cows changes grazing behavior and improves productivity.

Twenty Holstein cows were blocked in 2 groups according to milk yield to evaluate the effect of frequency of allocation to new grazing plots on pasture intake, grazing behavior, rumen characteristics, and milk yield. The 2 treatments, daily allocation to 0.125-ha plots (1D) or allocation every 4 d to 0.5-ha plots (4D) of Lolium perenne L., were tested in a randomized block design (2 rotations with 3 or 4 measuring periods of 4 d each) with mixed model analysis accounting for repeated measures. There were no differences in the chemical composition of offered pasture and in pasture dry matter intake (DMI) between 1D and 4D. However, an interaction between treatment and rotation indicated a difference in pasture DMI between treatments during the first rotation (4D, 16.5 vs. 1D, 18.3 kg/d) but not during the second rotation (4D, 15.0 vs. 1D, 14.7 kg/d), possibly a result of a greater pasture mass in the first rotation. Grazing time (average 562 min/d) and ruminating time (average 468 min/d), observed using IGER graze recorders, were similar between treatments, but grazing time increased numerically (549 to 568 min/d), and ruminating time decreased linearly (471 to 450 min/d) within periods in the 4D treatment. Mean rumen pH (6.16 vs. 6.05) and rumen NH(3)-N concentration (113.7 vs. 90.1 mg/L) were higher in 4D than in 1D, and total volatile fatty acid (VFA) concentrations did not differ. Molar proportions of VFA, except butyrate, differed between treatments, causing the nonglucogenic to glucogenic VFA ratio to be greater in 4D than in 1D. Within days in the 4D treatment, the molar proportion of acetate increased and those of all other VFA decreased linearly. Rumen NH(3)-N concentration within the 4D treatment declined quadratically from 170.3 mg/L on d 1 to 80.7 mg/L on d 4. In contrast to rumen NH(3)-N concentration, milk urea content did not differ between treatments, but decreased quadratically from d 1 to 4 in the 4D treatment (from 26.7 to 20.7 mg/dL). Mean fat- and protein-corrected milk was greater in 1D than in 4D (23.5 vs. 22.8 kg/d), mainly due to a difference in milk yield (24.5 vs. 23.7 kg/d). Fat and protein content were slightly lower in the 1D than in the 4D treatment (3.66 vs. 3.76% and 3.28 vs. 3.34%, respectively). This study confirmed that increasing pasture allocation frequency from once every 4 d to every day improved milk production in grazing dairy cows, especially when offered pasture was high.

Effect of glucogenic vs. lipogenic diets on energy balance, blood metabolites, and reproduction in primiparous and multiparous dairy cows in early lactation.

Increasing the availability of glucogenic nutrients relative to lipogenic nutrients has been hypothesized to decrease the production of milk fat, to improve the energy balance (EB), and to decrease the incidence and severity of metabolic and reproductive disorders in dairy cows in early lactation. Therefore, our objective was to evaluate the effects of a glucogenic, lipogenic, or mixed diet on EB, plasma metabolites and metabolic hormones, liver triacylglycerides (TAG), and reproductive variables in high-producing dairy cows in early lactation. Cows (n = 114) were randomly assigned to 1 of 3 diets and were fed either a mainly lipogenic diet, a mainly glucogenic diet, or a mixture of both diets (50:50 dry matter basis) from wk 3 before the expected calving date until 9 wk postpartum. Diets were isocaloric (net energy basis) and equal in intestinal digestible protein. Dry matter intake, net energy intake, milk yield, and milk protein percentage did not differ among diets. Milk lactose percentage was less for cows fed the lipogenic diet. Milk fat percentage was less for multiparous cows fed the glucogenic diet compared with cows fed the mixed or lipogenic diet (3.69 vs. 4.02 vs. 4.22 +/- 0.07%, respectively). The calculated EB was less negative for multiparous cows fed the glucogenic diet compared with cows fed the mixed or lipogenic diet [-33 vs. -125 vs. -89 +/- 21 kJ/(kg(0.75) x d), respectively]. Postpartum, the glucogenic diet decreased plasma nonesterified fatty acids, beta-hydroxybutyrate, and liver TAG concentrations and increased insulin concentration in multiparous cows. The glucogenic diet tended to decrease the number of days until first milk progesterone rise in multiparous cows compared with the mixed or lipogenic diet (20.4 vs. 24.4 vs. 26.4 +/- 2.1 d, respectively). Diet had no effect on any of the above-mentioned variables in primiparous cows, except that milk lactose percentage was greater for primiparous cows fed the glucogenic diet. We concluded that the glucogenic diet was effective in improving the calculated EB and decreasing plasma beta-hydroxybutyrate and liver TAG concentrations, suggesting a reduced risk of metabolic disorders in multiparous dairy cows fed a glucogenic diet.

Dietary energy source in dairy cows in early lactation: energy partitioning and milk composition.

Metabolic problems related to negative energy balance suggest a role for the balance in supply of lipogenic and glucogenic nutrients. To test the effect of lipogenic and glucogenic nutrients on energy partitioning, energy balance and nitrogen balance of 16 lactating dairy cows were determined by indirect calorimetry in climate respiration chambers from wk 2 to 9 postpartum. Cows were fed a diet high in lipogenic nutrients or a diet high in glucogenic nutrients from wk 3 prepartum until wk 9 postpartum. Diets were isocaloric (net energy basis) and equal in intestinal digestible protein. There was no effect of diet on metabolizable energy intake and heat production. Cows fed the lipogenic diet partitioned more energy to milk than cows fed the glucogenic diet [1,175 +/- 18 vs. 1,073 +/- 12 kJ/(kg(0.75) x d)] and had a higher milk fat yield (1.89 +/- 0.02 vs. 1.67 +/- 0.03 kg/d). The increase in milk fat production was caused by an increase in C16:0, C18:0, and C18:1 in milk fat. No difference was found in energy retained as body protein, but energy mobilized from body fat tended to be higher in cows fed the lipogenic diet than in cows fed the glucogenic diet [190 +/- 23 vs. 113 +/- 26 kJ/(kg(0.75) x d)]. Overall, results demonstrate that energy partitioning between milk and body tissue can be altered by feeding isocaloric diets differing in lipogenic and glucogenic nutrient content.

Dietary energy source in dairy cows in early lactation: metabolites and metabolic hormones.

Negative energy balance-related metabolic disorders suggest that the balance between available lipogenic and glucogenic nutrients is important. The objectives of this study were to compare the effects of a glucogenic or a lipogenic diet on liver triacylglycerides (TAG), metabolites, and metabolic hormones in dairy cows in early lactation and to relate metabolite concentrations to the determined energy retention in body mass (ER). Sixteen dairy cows were fed either a lipogenic or glucogenic diet from wk 3 prepartum to wk 9 postpartum (pp) and were housed in climate respiration chambers from wk 2 to 9 pp. Diets were isocaloric (net energy basis). Postpartum, cows fed a lipogenic diet tended to have higher nonesterified fatty acid concentration (NEFA; 0.46 +/- 0.04 vs. 0.37 +/- 0.04 mmol/L) and lower insulin concentration (4.0 +/- 0.5 vs. 5.5 +/- 0.6 microIU/mL). No difference was found in plasma glucose, beta-hydroxybutyrate, insulin-like growth factor-I, and thyroid hormones. Liver TAG was equal between both diets in wk -2 and 2 pp. In wk 4 pp cows fed the glucogenic diet had numerically lower TAG levels, although there was no significant dietary effect. Negative relationships were detected between ER and milk fat and between ER and NEFA. A positive relationship was detected between ER and insulin concentration. Overall, results suggest that insulin plays a regulating role in altering energy partitioning between milk and body tissue. Feeding lactating dairy cows a glucogenic diet decreased mobilization of body fat compared with a lipogenic diet. The relative abundance of lipogenic nutrients, when feeding a more lipogenic diet, is related to more secretion of lipogenic nutrients in milk, lower plasma insulin, and higher plasma NEFA concentration.