The relationships between sediment findings and culture results and the presence of proteinuria in canine urine samples.

OBJECTIVES: To assess relationships between urine sediment and microbial culture findings and the presence of proteinuria in canine urine samples, and to assess the change in the percentage of proteinuric samples and urine protein-to-creatinine ratio when urine abnormalities resolve. MATERIALS AND METHODS: Canine urine samples collected via cystocentesis and submitted for culture and contemporaneous urinalysis (including urine protein-to-creatinine ratio) were retrospectively identified. Dogs receiving corticosteroids were excluded. Associations between haematuria (red blood cells>5/high-power field), pyuria (white blood cells>5/high-power field), presence of microorganisms on microscopy, active sediment, and positive culture and proteinuria (urine protein-to-creatinine ratio>0.5) were investigated. Patient characteristics were considered possible confounders. In dogs with repeat urinalysis, the associations between active sediment and positive culture resolution on proteinuria and urine protein-to-creatinine ratio were assessed. RESULTS: One hundred and ninety-two of 491 samples were proteinuric (39.1%). Age was positively associated with proteinuria. In the multivariable analysis corrected for age, active sediment was the only variable significantly associated with proteinuria (adjusted odds ratio: 2.12; 95% confidence interval: 1.44 to 3.11); however, only 49.8% of samples with active sediment were proteinuric. Neither resolution of active sediment nor positive culture were associated with reduced proportions of proteinuric samples (from 57.9% to 42.1% and from 40.0% to 25.0%, respectively) or significant reductions in urine protein-to-creatinine ratio (median change: -0.16 and -0.14, respectively). CLINICAL SIGNIFICANCE: Attributing proteinuria to urinalysis abnormalities or a positive urine culture in canine cystocentesis samples is not supported by our findings, and could result in alternative causes of proteinuria (e.g. renal proteinuria) being overlooked.

Accessing National Health Service Stop Smoking Services in the UK: a COM-B analysis of barriers and facilitators perceived by smokers, ex-smokers and stop smoking advisors.

OBJECTIVE: Smokers who access free National Health Service (NHS) Stop Smoking Services (SSS) in the UK are four times more likely to stop smoking, yet uptake of the services has been in decline in recent years. Evidence was collated to explore the beliefs of smokers, ex-smokers and Stop Smoking Advisors (SSAs) about SSS and the barriers and facilitators to access. STUDY DESIGN: Mixed-methods design including i) a search of the literature; ii) a cross-sectional online questionnaire completed by 38 smokers and ex-smokers; and iii) semistructured interviews with 5 SSAs. METHODS: PubMed, Web of Science, Scopus, Prospero and the NIHR Portfolio were searched in October 2017 to identify relevant studies. Smokers and ex-smokers were recruited to the online questionnaire via Public Health websites and social media in Warwickshire. SSAs identified via Public Health Warwickshire were invited to take part in an interview conducted over the telephone. Findings were collated and analysed using the COM-B ('Capability', 'Opportunity', 'Motivation' and 'Behaviour') model framework. RESULTS: A range of practical and psychological or belief-based barriers and facilitators to accessing SSS were identified within all the components of the COM-B model, aside from physical capability, for example; 'Psychological capability', such as lack of understanding about what the service offers; 'Reflective motivation', such as lack of confidence in service efficacy; and 'Social opportunity', such as recommendations from healthcare professionals to attend. Suggestions and consideration on how future tobacco control intervention and public health messages can address these components are reported. CONCLUSIONS: Public health interventions and campaigns may benefit from focussing on addressing the well-known perceived barriers and facilitators smokers experience, in particular focussing on the components of the COM-B that have been identified as being important to increase the uptake of SSS.