A Qualitative Pilot Study of Pediatricians' Approach to Childhood Obesity.

IMPORTANCE: Over the past 3 decades, rates of childhood obesity have tripled. Given the gravity of this health concern, it is important that physicians intervene early. However, physicians continue to underdiagnose and undertreat childhood overweight and obesity. OBJECTIVE: The aim of this pilot study was to identify current tools and strategies used by pediatricians in regard to childhood obesity, as well as to reassess barriers to success, and to uncover areas for improvement. DESIGN: One-on-one interviews were conducted with pediatricians during the summer of 2013. Seven of the interviews occurred in person, and 10 occurred via telephone. Each interview lasted 30 to 60 minutes. All interviewees (n = 17, 13.2% response rate) were Wisconsin pediatricians, representing 7 different health systems. MAIN OUTCOMES: Themes relating to pediatrician's experiences in addressing and managing childhood obesity. RESULTS: Pediatricians interviewed in this survey are comfortable identifying and diagnosing pediatric obesity with the widespread use of electronic health records. They have several tools and strategies at their disposal for the treatment and management of obesity, but do not often achieve the desired outcome of achieving healthy body weight. Most of them lack connections to community resources and the ability to effectively communicate with referral systems outside of their clinic, such as with dietitians. CONCLUSIONS: Building stronger connections between physicians and dietitians, as well as between physicians and the local community, may allow physicians to feel more empowered when it comes to managing childhood obesity.

The health of wild red and sika deer in Scotland: an analysis of key endoparasites and recommendations for monitoring disease.

Monitoring the health of wildlife populations is important for understanding and controlling the risk of infections to livestock, humans and/or other wildlife. In this paper, we analyse the results of surveys of parasites and non-specific signs of diseases carried out on organs from 638 red and 107 sika deer culled in four regions of Scotland between 1991 and 1997. Infections of the lung by Elaphostrongylus spp. were significantly greater in red than sika deer. Older animals were more heavily infected with Elaphostrongylus spp. and Sarcocystis spp., and infections with Sarcocystis spp. tended to be heavier in more recent years. The results suggest that a combination of key indicator parasite species and non-specific signs of disease may be useful for monitoring the health of wildlife populations at a national scale. However, they also demonstrate that such monitoring needs to be long-term, carried out according to standard protocols and at an appropriate resolution to enable integration with data on other potentially influential environmental factors.

Nutrient input and removal trends for agricultural soils in nine geographic regions in Arkansas.

Knowledge of the balance between nutrient inputs and removals is required for identifying regions that possess an excess or deficit of nutrients. This assessment describes the balance between the agricultural nutrient inputs and removals for nine geographical districts within Arkansas from 1997 to 2001. The total N, P, and K inputs were summed for each district and included inorganic fertilizer and collectable nutrients excreted as poultry, turkey, dairy, and hog manures. Nutrients removed by harvested crops were summed and subtracted from total nutrient inputs to calculate the net nutrient balance. The net balances for N, P, and K were distributed across the hectarage used for row crop, hay, pasture, or combinations of these land uses. Row-crop agriculture predominates in the eastern one-third and animal agriculture predominates in the western two-thirds of Arkansas. Nutrients derived from poultry litter accounted for >92% of the total transportable manure N, P, and K. The three districts in the eastern one-third of Arkansas contained 95% of the row-crop hectarage and had net N and P balances that were near zero or negative. The six districts in the western two-thirds of Arkansas accounted for 89 to 100% of the animal populations, had positive net balances for N and P, and excess P ranged from 1 to 9 kg P ha(-1) when distributed across row-crop, hay, and pasture hectarage. Transport of excess nutrients, primarily in poultry litter, outside of the districts in western Arkansas is needed to achieve a balance between soil inputs and removals of P and N.

The ranging behaviour and habitat use of rabbits on farmland and their potential role in the epidemiology of paratuberculosis.

Grazing herbivores avoid grass swards contaminated with faeces as the ingestion of faeces is a common route of micro- and macro-parasite transmission. The recent novel finding that herbivores do not avoid grass swards contaminated with rabbit faeces suggests that disease risk posed to herbivores by rabbits is determined by rabbit ranging and excretory behaviour. Using as a case study rabbits and the risk Mycobacterium avium sub-species paratuberculosis (M. a. paratuberculosis) poses to cattle, the interaction between rabbits and grazing pasture was studied on an infected farm in the east of Scotland in spring and autumn 2000. Radio telemetry, burrow surveys and faecal pellet count data were collected on two areas (Areas 1 and 2) of the farm with different habitat mosaics, to study the potential effects of season and habitat on the spatial distribution of rabbits faeces and thus disease in the environment. Twenty one rabbits were radio tracked and a total of 902 fixes collected. Mean home range sizes (100% minimum convex polygons) were between 2.0 and 7.1 ha per rabbit per season. Home ranges were significantly larger in spring, and in Area 1 which had more moor and woodland and less rough pasture. Rabbits used rough pasture most in Area 1 and gorse scrub in Area 2. In both areas, significantly more burrows were located in gorse scrub than in any other habitat. Most faecal pellets were deposited on the moorland habitat of Area 2 in autumn. In habitats to which grazing livestock had access, the mean rate of faecal deposition was 8571 pellets per ha per day. The greatest risk of disease transmission occurred in habitats of poor grazing quality (e.g., gorse scrub) which were used by rabbits for burrowing and thus contained high concentrations of faeces. The findings of the study are discussed in relation to management practices aimed at reducing disease risk to livestock, including the fencing of scrub and the reduction of rabbit population size to prevent expansion of rabbit burrows from scrub into grazing pastures.

Do non-ruminant wildlife pose a risk of paratuberculosis to domestic livestock and vice versa in Scotland?

Paratuberculosis (Johne's disease) was long considered only a disease of ruminants. Recently non-ruminant wildlife species have been shown to harbor Mycobacterium avium subsp. paratuberculosis, the causative organism of paratuberculosis. We review the known non-ruminant wildlife host range of M. avium subsp. paratuberculosis and consider their role in the epidemiology of paratuberculosis in domestic ruminant livestock. Mycobacterium avium subsp. paratuberculosis has been isolated from lagomorph, canid, mustelid, corvid, and murid species. In agricultural environments domestic ruminants may contact wildlife and/or their excreta when grazing or feeding on farm-stored feed contaminated with wildlife feces, opening up the possibility of inter-species transmission. Of the wildlife species known to harbor M. avium subsp. paratuberculosis in Scotland, the rabbit is likely to pose the greatest risk to grazing livestock. Paratuberculosis in domestic ruminants is a notoriously difficult disease to control; the participation of non-ruminant wildlife in the epidemiology of the disease may partially account for this difficulty.