The effect of alternative feeding strategies on the feeding motivation of broiler breeder pullets.

Due to genetic selection for fast growth and high breast meat yield, commercial strains of broiler chickens and broiler breeders are predisposed to high feed intake; however, feeding broiler breeders ad libitum impairs their health and reproductive performance. Broiler breeders are feed-restricted throughout rearing to maintain health and performance, yet feed restriction results in hunger, feeding frustration and lack of satiety. The objective of this study was to examine the effect of alternative feeding strategies, including feed additives (separately or combined) and a fixed non-daily feeding schedule, on the feeding motivation and welfare of broiler breeders during rearing. At 3 weeks of age, 180 Ross 308 breeder pullets were allocated to 90 cages and fed with one of five isocaloric treatments: (1) daily control diet (control), (2) daily calcium propionate diet (CaP), (3) daily soybean hull diet (SBH), (4) daily alternative diet (alternative: CaP + SBH) and (5) 4/3 control diet (four on-feed days and three non-consecutive off-feed days per week). The CaP diet included calcium propionate at 1.4% from 3 to 6 weeks of age, and at 3.2% from 7 to 12 weeks of age, and the SBH diet contained soybean hulls included at 40%. The alternative diet included both soybean hulls and calcium propionate at the same inclusion rate as the SBH and CaP diets, respectively. Pullets were weighed and scored for feather coverage every week. A feed intake test was conducted at 3, 4, 8, 10 and 11 weeks of age for 10 min during on- and off-feed days. At 12 weeks of age, feather samples were analysed for fault bars. Data were analysed using linear mixed regression models, with cage nested in the models and age as a repeated measure. At 4 weeks of age, pullets fed soybean hull-enriched diets (SBH and alternative diets) and those on the 4/3 schedule had lower feed intake than control pullets (P = 0.02). Feathers from pullets fed the SBH diet had fewer fault bars than those fed the CaP diet (P = 0.04). The results indicated that the inclusion of soybean hulls (alone or combined with calcium propionate) and a 4/3 feeding schedule can reduce feeding motivation of broiler breeders during early rearing.

The effect of alternative feeding strategies for broiler breeder pullets: 2. Welfare and performance during lay.

Feeding broiler breeders to satiety has negative consequences on their health and reproduction. Alternative feeding strategies during rearing can improve welfare, although their implications during lay are not well understood. The objective was to examine the effect of rearing feeding treatments on the reproductive performance and feeding behavior of broiler breeders under simulated commercial conditions. At 3 wk of age, 1,680 Ross 308 pullets were allocated to 24 pens under 1 of 4 isocaloric treatments: 1) daily control diet; 2) daily alternative diet (40% soybean hulls and 1 to 5% calcium propionate); 3) 4/3 control diet (4 on-feed days, 3 non-consecutive off-feed days per week); and 4) graduated control diet. Feeding frequency of the graduated treatment varied with age and finished on a daily basis. At 23 wk of age, group sizes were adjusted to 40 hens, and 5 mature Yield Plus Males roosters were introduced to each pen. Pens were under the same daily feeding management and same diet during lay. The performance of broiler breeders (growth rate, body weight uniformity, and reproductive performance) was determined until 64 wk of age. At the end of lay, feeding motivation was examined with a feed intake test and a compensatory feeding test. Data were analyzed using linear mixed regression models, with pen nested in the models and age as a repeated measure. The laying rate of hens reared on the graduated treatment decreased slower compared to control hens, resulting in a higher cumulative egg production (178.2 ± 3.8 eggs/hen) than control hens (165.2 ± 3.8 eggs/hen, P < 0.01) by 64 wk of age. Hens reared on non-daily feeding treatments laid lighter eggs with relatively heavier yolks and had higher feed intake at the end of lay than hens fed daily during rearing (P = 0.02). In conclusion, rearing feeding treatments impacted the growth rate and body weight uniformity during lay, feeding motivation at the end of lay, and the laying rate and hatchability depending on hens' age.

Utilization of soy hulls, oat hulls, and flax meal fiber in adult broiler breeder hens.

A total of 72, 65-week-old broiler breeder hens (Ross 308, BW 4,190 ± 45 g) was placed in individual cages to investigate utilization of fiber in soy hulls (SH), oat hulls (OH), and flax meal (FM). Birds were adapted to cages for 10 d prior to allocation (n = 18) to broiler breeder ration (control) or control mixed with either of the 3 fiber sources (wt/wt) added to supply equal amounts of neutral detergent fiber (NDF) ∼21% and TiO2. The daily feed allocation was based on 4% BW. Feed intake (FI) was monitored daily, and grab excreta samples were taken on d 16 and 17. On d 18, all birds were weighed and killed 2 h post feeding to measure ceca digesta pH and short chain fatty acids (SCFA). Relative to the control birds, birds receiving fiber lost (P < 0.05) BW due to decreased (P < 0.05) FI. The BW changes were respectively +80, -174, -133, and -585 g/bird for control, SH, OH, and FM, and corresponding FI was 1,062, 918, 885, and 590 g/bird. Birds fed FM retained higher (P < 0.05) NDF than birds fed either SH or OH. The ceca digesta pH was lower (P < 0.05) in birds receiving added fiber relative to control. However, ceca digesta pH of FM fed birds was lower (P < 0.05) than in birds fed either SH or OH, which were in turn similar (P > 0.05). Birds fed FM had higher (P < 0.05) concentration of butyric acid than birds fed the control diets, while birds fed SH and OH had intermediate butyric acid concentration. Acetic acid and total SCFA concentrations were higher (P < 0.05) in birds fed OH diet than in birds fed control but was similar (P > 0.05) to that in birds fed either SH or FM. In conclusion, short term feeding of fibrous feed ingredients reduced BW linked to reduced FI. Fiber sources exhibited differences in utilization reflective of chemical characteristics.

[The cost of cerebrovascular accident]. / Coste de la enfermedad cerebrovascular aguda.

INTRODUCTION AND AIM: One out of three persons will die of cerebrovascular accident (CVA), another one will be disabled, and the third one will recover. This research has been taken to estimate the costs of CVA in the Basque Country. MATERIALS AND METHODS: The cost of illness is studied from a societal perspective. It is based on the prevalence of the disease. Population costs has been estimated from the use of resources of a randomized sample of patients admitted to hospital with stroke during the year 2000, and followed for 12 months. Transitions costs (those that happen just once) and state costs (those remaining in patients lifetime) have been studied separately. RESULTS: The prevalence of CVA was 1.780 x 10(5). Average transition cost per patient was 4,762 euros and average state cost for patient/year was 10,506 euros. The estimated cost for the Basque Country is 120,249,986 euros in the year 2000. Transition costs were 16,460,729 euros and state costs 103,789,257 euros in the same year. State costs were due to disability. CONCLUSIONS: The analysis of the costs of CVA from a societal perspective gets us to the heart of illness causing disability, the social costs of CVA are 74.3% of the total cost.

[Hospital care of cerebrovascular accident and the state of patients 12 months after]. / Atención hospitalaria a la enfermedad cerebrovascular aguda y situación de los pacientes a los 12 meses.

OBJECTIVES: Cerebrovascular accident should be of key importance due to its magnitude in terms of mortality and disability. In this study we describe hospital care of patients and follow them one year after. The aims is to uncover areas of improvement in the care of patients. PATIENTS AND METHODS: Observational study of a randomized sample of 535 patient with a diagnosis of cerebrovascular disease, during de acute phase and 12 months after, using clinical records and telephone interview. RESULTS: Thirty five percent of patients arrived within 6 hours of the occurrence of the event. Thirty six percent had a CAT/MNR within 6 hours. Mortality at hospital was 13.8% increasing up to 26% at 12 months. At discharge 49% had a neurological deficiency. At 12 months 35.8% of the survivors interviewed showed a Barthel Index of less than 95 points. CONCLUSIONS: Organizational measures that guarantee a quick and systematic assessment of brain lesions, early diagnosis and active therapeutic offer, have to be implemented. In the sample studied, only 3% of the patient were candidates to thrombolytic therapy. Rehabilitation can and should play a more relevant role in the prevention of sequelae.

Erythrocyte anion exchanger activity and intracellular pH in essential hypertension.

The present study was designed to examine the activity of the sodium-independent chloride-bicarbonate anion exchanger and the sodium-proton exchanger in erythrocytes of 30 normotensive and 35 hypertensive subjects and its relation to the previously reported decrease in erythrocyte pH. Erythrocyte cytosolic pH was measured by the pH-sensitive fluorescent probe 2'-7'-bis(2-carboxyethyl)- 5(6)-carboxyfluorescein. The activity of the anion exchanger was determined by acidifying cell pH and measuring the initial rate of the net sodium-independent, 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid-sensitive, bicarbonate influx driven by an outward proton gradient. The activity of the sodium-proton exchanger was determined by acidifying cell pH and measuring the initial rate of the net sodium-dependent proton efflux driven by an outward proton gradient. The activity of the anion exchanger was higher in hypertensive than control individuals (18,863 +/- 1081 vs 15,629 +/- 897 mmol/L cells per hour, P < .05). The activity of the sodium-proton exchanger was higher in hypertensive than control individuals (301 +/- 45 vs 162 +/- 23 mmol/L cells per hour, P < .005). Basal erythrocyte pH was lower in hypertensive than control individuals (7.27 +/- 0.02 vs 7.33 +/- 0.01, mean +/- SEM, P < .05). With the 100% confidence (lower) limit of the normotensive population as a cutoff point, a subgroup of 11 hypertensive patients had an abnormally low erythrocyte pH (< 7.19).(ABSTRACT TRUNCATED AT 250 WORDS)

Enhanced Na(+)-H+ exchanger activity and NHE-1 mRNA expression in lymphocytes from patients with essential hypertension.

It has been demonstrated that the activity of the sodium-proton exchanger (NHE-1 isoform) is increased in lymphocytes and other blood cells from patients with essential hypertension. In the present study, we investigated whether an increased level of NHE-1-specific mRNA in lymphocytes from patients with essential hypertension would explain the enhanced transport activity. Twenty-two hypertensive patients and 21 normotensive subjects were studied. Basal cytosolic pH was measured by the pH-sensitive fluorescent probe 2',7'-bis(2-carboxyethyl)-5(6)-carboxyfluorescein. Maximal sodium-proton exchange activity was determined by acidifying cell pH and measuring the initial rate of the net sodium-dependent proton efflux driven by an outward proton gradient. The transcript level of NHE-1 was measured by reverse transcription-polymerase chain reaction in comparison with a constitutively expressed reference gene (beta-actin). Intracellular pH was lower in hypertensive patients than normotensive subjects (7.34 +/- 0.01 versus 7.39 +/- 0.01, mean +/- SEM, P < .001). The maximal activity of the sodium-proton exchanger was higher in hypertensive patients than in normotensive subjects (1262 +/- 100 versus 881 +/- 56 mmol/L cells per hour, P < .01). NHE-1 mRNA was increased in hypertensive patients compared with normotensive subjects (ratio of NHE-1 mRNA to beta-actin mRNA, 0.16 +/- 0.01 versus 0.12 +/- 0.02, P < .05). These data suggest that the increased sodium-proton exchange activity in essential hypertension may be related to the de novo synthesis of exchanger protein.

Is there increased cardiovascular risk in essential hypertensive patients with abnormal kinetics of red blood cell sodium-lithium countertransport?

Na+ transport kinetics were studied in red blood cells (RBCs) from 50 essential hypertensive patients and 30 normotensive controls. Seven hypertensive patients were characterized by the following: (1) a maximal rate of Na+-Li+ countertransport higher than an upper normal limit of 525 mumol.litre cells-1.h-1; (2) an apparent dissociation constant for internal Na+ higher than an upper normal limit of 20.4 mmol.litre cells (in only five of the seven hypertensives); (3) no other kinetic abnormality in Na+,K+ pump, Na+,K+ cotransport or passive Na+ permeability. Clinically, hypertensives with abnormal countertransport were characterized by high serum low-density lipoprotein (LDL) cholesterol levels and the presence of electrocardiographic left ventricular hypertrophy (LVH). Conversely, mean values of these two clinical parameters were normal in the remaining hypertensive patients, independently of the presence of other abnormalities in Na+,K+ pump, Na+,K+ cotransport or passive Na+ permeability. In conclusion, the presence of abnormal Na+-Li+ countertransport kinetics in erythrocytes may be associated with an enhanced cardiovascular risk in hypertension.

Increased activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger in erythrocytes of patients with essential hypertension.

OBJECTIVE: To study the activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger in erythrocytes of patients with essential hypertension. DESIGN: The study was performed in cells from 48 untreated essential hypertensive patients and 30 normotensive controls with similar age- and sex- distribution. METHODS: The activity of the Na(+)-dependent anion exchanger was determined by measuring the 4,4'-diisothiocyanostilbene-2,2'-disulfonate (DIDS) sensitive Li+ influx in fresh cells incubated into a medium containing Li2CO3. RESULTS: The DIDS-sensitive Li+ influx was higher in hypertensives than controls. With the 100% confidence (upper) limit of the normotensive population as a cut-off point, a subgroup of 11 hypertensives had an abnormally high activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger. Compared with patients with normal exchanger activity, patients with increased exchanger activity were characterized by the following: higher frequency of family history of hypertension; lower serum high-density lipoprotein cholesterol levels and higher plasma aldosterone concentrations. After multiple regression analysis, the DIDS-sensitive Li+ influx was inversely correlated with high-density lipoprotein cholesterol levels. CONCLUSIONS: These results show the presence of a new abnormality of erythrocyte Na+ transport in essential hypertension--increased activity of the Na(+)-dependent Cl(-)-HCO3- anion exchanger. In addition, our findings suggest that from the clinical point of view, patients with this transport abnormality represent a particular subset of essential hypertensives.

Correspondences between the activity of the renin-angiotensin system and the erythrocyte Na+ transport abnormalities in hypertension.

Plasma renin activity and the relationship of renin activity and sodium excretion were analyzed in 50 untreated essential hypertensives classified according to their erythrocyte Na+ transport abnormalities. Renin activity was inappropriately high in 7 patients with increased activity of Na+,Li+ countertransport, inappropriately low in 12 patients with decreased activity of Na+,K+,Cl- cotransport and normal in 31 patients without either Na+ transport abnormalities. These results suggest that there are correspondences between the activity of the renin-angiotensin system and the main Na+ transport abnormalities present in erythrocytes of patients with essential hypertension.

Association of increased erythrocyte Na+/H+ exchanger with renal Na+ retention in patients with essential hypertension.

The goal of this study was to investigate the activity of the Na+/H+ exchanger in erythrocytes of patients with essential hypertension and its relation with urinary Na+ excretion. The study was performed in cells from 27 untreated hypertensive patients and 30 normotensive controls with similar age and sex distribution. All subjects were studied after 4 days on a controlled Na+ diet (145 mmol/day). The activity of the Na+/H+ exchanger was determined by acidifying cell pH and measuring the initial rate of the net Na(+)-dependent H+ efflux. The activity of the Na+/H+ exchanger was higher in hypertensive patients than in controls (301 +/- 45 v 162 +/- 23 mmol/L cells/h, mean +/- SEM; P < .01). With the upper limit of the normotensive population as a cut-off point (385 mmol/L cells/h), a subgroup of 12 hypertensive patients had an abnormally high activity of Na+/H+ exchanger. Compared with controls and with patients with normal exchanger activity, patients with increased exchanger activity were characterized by lower net (P < .01) and fractional (P < .05) Na+ excretion. The accumulative Na+ balance was higher (P < .01) in hypertensive patients with increased activity of the exchanger (39.90 +/- 3.47 mmol) than in the remaining hypertensive patients (0.59 +/- 6.96 mmol) or in the normotensive population (-5.71 +/- 6.12 mmol). After analyzing the relationship of renin activity with Na+ excretion it was observed that renin activity was inappropriately low in 9 (75%) patients with increased exchanger, in 6 (40%) patients with normal exchanger, and in 6 (20%) normotensives, these differences being significant (P<.01).

An evidence-based programme for smoking cessation: effectiveness in routine general practice.

BACKGROUND: Smoking cessation clinical practice guidelines are based on randomised clinical trials reporting outcomes in persons who participate in these studies. However, many practitioners are sceptical about the effectiveness of these recommendations when applied to the general population in everyday routine consultation. AIM: To evaluate the results of a comprehensive smoking cessation programme in routine primary care practice. METHOD: All smokers consulting in 10 general practices during one year participated in a non-randomised controlled trial. The percentages of subjects in the intervention (n = 1203, seven practices) and control (n = 565, three practices) groups who reported sustained abstinence between six and 12 months follow-up and were validated biochemically were compared. The effect of the programme was adjusted to baseline differences in both groups by multiple logistic regression analyses. RESULTS: The programme resulted in an increase of five percentage points (95% CI = 3.1%-6.8%) in the validated and sustained one-year abstinence probability, with 7.1% for all of the intervention practices (adjusted OR = 3.7, 95% CI = 2.4-5.7). CONCLUSION: Programmes that combine advice to stop smoking to all smokers attending general practices with the offering of support, follow-up, and nicotine patches to those willing to stop are feasible and effective in routine practice, as primary care clinicians need only identify 20 smokers to get one additional success attributable to the programme.

[Population-based epidemiology of colorectal cancer: causality review]. / Epidemiología poblacional de cáncer colorrectal: revisión de la causalidad.

The estimated number of new cases of colorectal cancer per year in Spain (no. 19,166) is higher than other tumour locations. 1.56 times more cases of colon cancer are registered than of the rectum, and there are 1.44 times more cases in men than in women. Incidence and mortality are lower than the average for European countries; in historical series (1973-1999) an increase can be observed by age, period and birth cohorts between 1898 and 1932. On the contrary, in the USA a reduction of mortality can be observed from 1973 to 1999 (-20.8%) and of incidence from 1985 to 1999 (-7.4%). In Spain, the average duration of the disease in years is 4.29, lower than that of the European Community (4.57), and 72% of the figure for the most favourable country (5.93). Relative survival after five years in Spain is lower than in the USA (61.9% vs. 54%). Several dietary, environmental and lifestyle factors appear to be associated with colorectal cancer, but the risk or protection of these factors are of little weight and the results of studies are at times contradictory. The reduction of incidence in the USA indicates that intervention is possible to bring about a change of trend, predictably by means of secondary prevention.

Oxysterols: A world to explore.

Oxysterols (oxidized derivatives of cholesterol and phytosterols) can be generated in the human organism through different oxidation processes, some requiring enzymes. Furthermore, oxysterols are also present in food due to lipid oxidation reactions caused by heating treatments, contact with oxygen, exposure to sunlight, etc., and they could be absorbed from the diet, at different rates depending on their side chain length. In the organism, oxysterols can follow different routes: secreted into the intestinal lumen, esterified and distributed by lipoproteins to different tissues or degraded, mainly in the liver. Cholesterol oxidation products (COPs) have shown cytotoxicity, apoptotic and pro-inflammatory effects and they have also been linked with chronic diseases including atherosclerotic and neurodegenerative processess. In the case of phytosterol oxidation products (POPs), more research is needed on toxic effects. Nevertheless, current knowledge suggests they may also cause cytotoxic and pro-apoptotic effects, although at higher concentrations than COPs. Recently, new beneficial biological activities of oxysterols are being investigated. Whereas COPs are associated with cholesterol homeostasis mediated by different mechanisms, the implication of POPs is not clear yet. Available literature on sources of oxysterols in the organism, metabolism, toxicity and potential beneficial effects of these compounds are reviewed in this paper.

Enhanced renal PGE2 in hypertensives with increased red cell Na(+)-Li+ countertransport.

In this study, maximal velocities of Na(+)-Li+ countertransport were measured in red blood cells of 50 untreated essential hypertensives and 30 normotensive controls. In addition, urinary excretion of renal prostaglandins (PG) and plasma renin activity (PRA) was measured in each subject. Maximal velocity of Na(+)-Li+ countertransport was above the upper limit in controls of 525 mumol.l cell-1.h-1 in seven patients and was normal in the remaining patients. Patients with increased countertransport did not differ significantly from controls and from patients with normal countertransport with regard to urinary excretion of 6-keto-PGF1 alpha (the stable metabolite of prostacyclin) and thromboxane B2 (TxB2) (the stable metabolite of thromboxane A2). In contrast, mean values of PGE2 were significantly higher (P less than 0.01) in patients with increased countertransport (411 +/- 39 pg/min) compared with patients with normal countertransport (181 +/- 15 pg/min) and controls (146 +/- 13 pg/min). In addition, six patients with increased countertransport exhibited urinary levels of PGE2 higher than the upper limit in controls. Hypertensives with increased countertransport showed enhanced PRA when compared with the remaining patients (2.96 +/- 0.50 vs. 1.30 +/- 0.52 ng.ml-1.h-1, P less than 0.05) and with controls (1.86 +/- 0.08 ng.ml-1.h-1, P less than 0.05). Finally, the relationship between PGE2 and PRA was found to be significant in patients with increased countertransport (r = 0.776, P less than 0.05). These results indicate that renal synthesis of PGE2 is enhanced in essential hypertensives with increased Na(+)-Li+ countertransport activity and hyperreninemia.

Is the erythrocyte sodium-lithium countertransport a molecular marker of cardiac risk in hypertension?

Current research is being directed toward the identification of markers of cardiac risk in hypertension, according to demographic, clinical, genetic, challenge-response and laboratory predictors. Much interest has centered around cationic transporters as laboratory markers, not only because they might make good predictors of cardiac risk, but also because of their potential for explaining the pathophysiology of that disorder. To date, there is no cationic transporter that clearly discriminates between subjects with low and with high cardiac risk, although the sodium-lithium (Na(+)-Li+) countertransport in red blood cells has come the closest. High rates of Na(+)-Li+ countertransport have been found to be associated not just with essential hypertension but more specifically with subgroups of patients suffering from essential hypertension who have a higher frequency of severe hypertension and increased risk of cardiac disease. Here, we examine different lines of clinical evidence suggesting that increased Na(+)-Li+ countertransport activity may identify patients with essential hypertension who are at an increased risk of cardiac disease because they also present other cardiac risk factors, namely hyperlipidemia and/or left ventricular hypertrophy. In addition, the pathophysiological basis for the association of hypertension and the above cardiac risk factors with increased Na(+)-Li+ countertransport are discussed.

[Stimulation of the hydrolytic activity of Na+,K+-ATPase in the erythrocytes by arginine vasopressin]. / Estimulación de la actividad hidrolítica de la Na+, K+-ATPasa eritrocitaria por la arginina vasopresina.

The effects of arginine vasopressin (AVP) on Na+,K+-ATPase activity in human erythrocytes have been studied. AVP stimulates enzymatic activity with no effect on transport activity. Since the enzymatic reaction with AVP can proceed in the absence of ion transport, it may explain the discrepancies between the in vivo and in vitro effects observed with the hormone on Na+ processing by the kidney.

[Can we help our patients to stop smoking?: the experience of the Smoking Cessation Program]. / Podemos ayudar a nuestros pacientes a dejar de fumar?: la experiencia del Programa de Abandono del Tabaco.

OBJECTIVE: To describe the process and results of the Smoking Cessation Program in order to answer this question: Does the lack of time and resources justify poor involvement of physicians in helping patients to stop smoking? METHODS: Prospective series of cases that included all smokers (n = 1203) who for any reason attended seven general practices over a period of one year. The behaviour of smokers when the program was offered as well as the workload generated by the implementation of the process are described. Subjects who stopped smoking were those who did not smoke two years after enrolment in a sustained and validated form for least 12 months. RESULTS: A total of 7.3% of all smokers quit (95% confidence interval [CI]: 5.9-8.9). Enrolment of subjects caused an increase in the consultation time of 23 seconds and decreased from a mean of 30 new smokers per month per practice during the first three months to 12 at the end of the first year. All received advise to stop smoking (mean increase of 3 min and 33 s) but only 17.5% accepted the therapeutic plan during the first year (95% CI: 15.4-19.9) that had a duration of 72:11 min and generated a mean of six programmed appointments a month in each practice. Twenty percent of subjects who participated in the therapeutic plan stopped smoking (95% CI: 14.8-26.1). CONCLUSIONS: Identification and universal advice to smokers, together with treatment of those who are motivated to quit, achieved important success rates without increasing excessively ordinary work loads.