Women's cardiovascular health - the cardio-oncologic jigsaw.

Improvements in cancer care have led to an exponential increase in cancer survival. This is particularly the case for breast cancer, where 5-year survival in Australia exceeds 90%. Cardiovascular disease (CVD) has emerged as one of the competing causes of morbidity and mortality among cancer survivors, both as a complication of cancer therapies and because the risk factors for cancer are shared with those for CVD. In this review we cover the key aspects of cardiovascular care for women throughout their cancer journey: the need for baseline cardiovascular risk assessment and management, a crucial component of the cardiovascular care; the importance of long-term surveillance for ongoing maintenance of cardiovascular health; and strong evidence for the beneficial effects of physical exercise to improve both cancer and cardiovascular outcomes. There is general disparity in cardiovascular outcomes for women, which is further exacerbated when both CVD and cancer co-exist. Collaboration between oncology and cardiac services, with an emergence of the whole field of cardio-oncology, allows for expedited investigation and treatment for these patients. This collaboration as well as a holistic approach to patient care and key role of patients' general practitioners are essential to ensure long-term health of people living with, during and beyond cancer.

Calf management and welfare in the Canadian and US dairy industries: Where do we go from here?

The objective of this narrative review was to compare the results of the 2015 Canadian National Dairy Study and the 2014 US National Animal Health Monitoring System (NAHMS) Dairy Studies, with a specific focus on calf management and welfare, and to interpret these findings within more recent calf health research to describe where we need to go next in the North American dairy industry. Situating results of periodic national studies within the context of past and recent research provides an opportunity to gauge adoption of recommendations and best practices and to help identify persistent and new challenges that the industry is wrestling with to help guide research needs. Through this review of the 2 national studies, we identified several strengths of the Canadian and US dairy industries. In each area of calf health management, improvements relative to previous NAHMS studies and the published literature have been found in the level of mortality, amount of colostrum fed, housing, and the number of producers using pain control for disbudding and dehorning. There were, however, some areas that present clear opportunities for improvement. Specifically, although mortality levels have improved, a large number of calves die at birth, within the first 48 h of life, and during the preweaning period. To improve the health of calves in early life, producers could look at feeding high-quality colostrum at 10% of body weight in the first feeding, as well as feeding a larger amount of milk during the preweaning period. The barriers to making these management changes and improving overall calf health need to be identified in future studies. The majority of preweaning calves in Canada and the United States are housed in individual housing. This represents a clear opportunity for improvement because recent research has identified the positive aspects of group housing. Finally, with respect to pain control, improvements are needed (particularly in the United States) to ensure that pain management is provided when disbudding and dehorning calves. Although the science is clear on pain management, discussions with producers are needed to identify reasons for the lack of uptake.

Consensus recommendations on calf- and herd-level passive immunity in dairy calves in the United States.

Passive immunity in calves is evaluated or quantified by measuring serum or plasma IgG or serum total protein within the first 7 d of age. While these measurements inform about circulating concentrations of this important protein, they are also a proxy for evaluating all of the additional benefits of colostral ingestion. The current individual calf standard for categorizing dairy calves with successful passive transfer or failure of passive transfer of immunity are based on serum IgG concentrations of ≥10 and <10 g/L, respectively. This cutoff was based on higher mortality rates in calves with serum IgG <10 g/L. Mortality rates have decreased since 1991, but the percentage of calves with morbidity events has not changed over the same time period. Almost 90% of calves sampled in the USDA National Animal Health Monitoring System's Dairy 2014 study had successful passive immunity based on the dichotomous standard. Based on these observations, a group of calf experts were assembled to evaluate current data and determine if changes to the passive immunity standards were necessary to reduce morbidity and possibly mortality. In addition to the USDA National Animal Health Monitoring System's Dairy 2014 study, other peer-reviewed publications and personal experience were used to identify and evaluate potential standards. Four options were evaluated based on the observed statistical differences between categories. The proposed standard includes 4 serum IgG categories: excellent, good, fair, and poor with serum IgG levels of ≥25.0, 18.0-24.9, 10.0-17.9, and <10 g/L, respectively. At the herd level, we propose an achievable standard of >40, 30, 20, and <10% of calves in the excellent, good, fair, and poor categories, respectively. Because serum IgG concentrations are not practical for on-farm implementation, we provide corresponding serum total protein and %Brix values for use on farm. With one-third of heifer calves in 2014 already meeting the goal of ≥25 g/L serum IgG at 24 h of life, this achievable standard will require more refinement of colostrum management programs on many dairy farms. Implementation of the proposed standard should further reduce the risk of both mortality and morbidity in preweaned dairy calves, improving overall calf health and welfare.

Management of preweaned bull calves on dairy operations in the United States.

Many calves born on dairy farms are male, but little research to date has focused on the management of these calves. The objective of this study was to survey management practices of preweaned dairy bull calves and compare these practices with those used for heifer calves on the same operations. This study was conducted as part of the USDA National Animal Health Monitoring System Dairy 2014 study and included a sample of 42 operations from 10 states. On average, 2.4% of bull calves died before leaving the operation, with most operations selling bull calves before weaning (97.6%). Bull calves left the operation at an average age of 7.6 d (median = 4 d). Producers reported that 96.3% of bull calves received colostrum. Of bulls that were fed colostrum, the vast majority (95.4%) were hand-fed; the remaining calves received colostrum via a combination of hand-feeding and suckling (3.1%) or by suckling only (1.5%). In contrast, all heifer calves on those operations were only hand-fed colostrum. On average, bull calves received 3.1 L of colostrum at their first feeding at 4.3 h after birth compared with 2.9 L at 2.9 h after birth for heifer calves. In the first 24 h, bull and heifer calves received 4.8 and 5.5 L of colostrum, respectively. Only 21.4% of operations dehorned bull calves; in comparison, heifer calves were dehorned on 90.5% of operations. Few operations used analgesics or anesthetics when dehorning bull calves, whereas 28.9% of operations used anesthetics or analgesics when dehorning heifer calves. Overall, 27.8% of operations castrated bull calves. Of the operations that did castrate bulls, 70.0% used a band at an average age of 6.3 wk; the remaining 30% of operations used a knife at 14.7 wk of age on average. Few operations used analgesics or anesthetics when castrating. These results illustrate differences in the care of bull and heifer calves and suggest the need to improve education regarding recommended colostrum feeding and pain management practices in all calves regardless of sex.

Proposed dairy calf birth certificate data and death loss categorization scheme.

The majority of dairy heifer calves in the United States are destined to be dairy replacements. However, many dairy heifer and bull calves die before 6 mo of age. Of these calves, about 6% (more than 500,000 calves) die at birth or shortly after (i.e., currently termed "stillbirth"). An additional 6% of dairy heifers die during the preweaning period. Death loss in dairy calves is primarily due to stillbirths, failure to adapt to extrauterine life, and infectious disease processes. The reasons for preweaning heifer calf deaths caused by infectious diseases are generally categorized based on easily recognizable clinical signs such as digestive disease/scours or respiratory disease. Most causes of calf death can be mitigated by appropriate preventive care or well-tailored treatments, meaning that the typical death loss percentage could be decreased with better management. Producers could gather information on the circumstances near birth and at death if they had appropriate guidance on what details to record and monitor. This paper provides recommendations on data to collect at the time of birth (i.e., calf birth certificate data). The recording of these critical pieces of information is valuable in evaluating trends over time in morbidity and mortality events in dairy calves. Ideally, necropsy examination would substantially improve the identification of cause of death, but even without necropsy, attribution of cause of death can be improved by more carefully defining death loss categories in on-farm record systems. We propose a death loss categorization scheme that more clearly delineates causes of death. Recommendations are provided for additional data to be collected at the time of death. Recording and analyzing birth certificate and death loss data will allow producers and veterinarians to better evaluate associations between calf risk factors and death, with the goal of reducing dairy calf mortality.

Estimating milk yield and value losses from increased somatic cell count on US dairy farms.

Milk loss due to increased somatic cell counts (SCC) results in economic losses for dairy producers. This research uses 10 mo of consecutive dairy herd improvement data from 2013 and 2014 to estimate milk yield loss using SCC as a proxy for clinical and subclinical mastitis. A fixed effects regression was used to examine factors that affected milk yield while controlling for herd-level management. Breed, milking frequency, days in milk, seasonality, SCC, cumulative months with SCC greater than 100,000 cells/mL, lactation, and herd size were variables included in the regression analysis. The cumulative months with SCC above a threshold was included as a proxy for chronic mastitis. Milk yield loss increased as the number of test days with SCC ≥100,000 cells/mL increased. Results from the regression were used to estimate a monetary value of milk loss related to SCC as a function of cow and operation related explanatory variables for a representative dairy cow. The largest losses occurred from increased cumulative test days with a SCC ≥100,000 cells/mL, with daily losses of $1.20/cow per day in the first month to $2.06/cow per day in mo 10. Results demonstrate the importance of including the duration of months above a threshold SCC when estimating milk yield losses. Cows with chronic mastitis, measured by increased consecutive test days with SCC ≥100,000 cells/mL, resulted in higher milk losses than cows with a new infection. This provides farm managers with a method to evaluate the trade-off between treatment and culling decisions as it relates to mastitis control and early detection.

Preweaned heifer management on US dairy operations: Part III. Factors associated with Cryptosporidium and Giardia in preweaned dairy heifer calves.

The objective of this study was to evaluate management practices and environmental factors associated with cryptosporidiosis and giardiasis in preweaned heifer calves on US dairy operations. This study was conducted as part of the calf component of the National Animal Health Monitoring System's Dairy 2014 study. The calf component included 104 dairy operations in 13 states and was an 18-mo longitudinal study focused on dairy heifer calves from birth to weaning. Fecal samples were collected from 2,249 calves: 839 calves in the West region (California, Colorado, and Washington) and 1,410 calves in the East region (Iowa, Michigan, Minnesota, Missouri, New York, Ohio, Pennsylvania, Vermont, Virginia, and Wisconsin). Fecal samples were collected only once from calves during the preweaning period. Samples were collected from calves 3 to 66 d of age, with a mean of 22 d. Overall, Cryptosporidium and Giardia were detected in 43.1 and 30.5% of fecal samples, respectively. Backward elimination logistic model selection was used after univariate screening to determine which management practices and environmental factors significantly affected the presence of Cryptosporidium or Giardia. The final Cryptosporidium model included herd size, days of age at fecal collection, and average temperature-humidity index for the month of fecal collection (fTHI). Cryptosporidium was found on a higher percentage of large operations (≥500 cows) than small operations (30 to 99 cows). Younger calves were more likely to have a fecal sample positive for Cryptosporidium than samples from older calves. Fecal samples from calves during the warmer parts of the year (fTHI >70) were more likely to be positive for Cryptosporidium than samples collected in colder months (fTHI <20). The final Giardia model included herd size, days of age at fecal collection, average fTHI, failure of passive transfer status, and average daily gain (kg/d) during the preweaning period. Giardia was isolated more frequently from calves on small operations than on large operations and from calves that were older compared with younger calves. Giardia was more frequently isolated in warmer months. Samples from calves with failure of passive transfer were more likely to have Giardia than calves with adequate passive transfer (>10 g/L IgG). Average daily gain during the preweaning period was lower in calves from which Giardia was isolated. These results highlight the factors associated with the presence of Cryptosporidium and Giardia in preweaned dairy heifer calves.

Preweaned heifer management on US dairy operations: Part IV. Factors associated with the presence of Escherichia coli O157 in preweaned dairy heifers.

Dairy calves shed pathogenic Escherichia coli O157 (O157) in feces and are a potential route of exposure for human infections. As part of the National Animal Health Monitoring System's (NAHMS) Dairy 2014 study, we evaluated farm, animal, and environmental factors associated with O157 presence in dairy heifer calves. For this O157 study, calves were enrolled from 100 dairy operations in 13 states. Each operation collected data from calves from birth to weaning over an 18-mo period. A single fecal sample was collected from 487 calves in western states and from 871 calves in eastern states (n = 1,358 total), and O157 was detected in 2.5% (n = 34) of fecal samples. Descriptive statistics and univariable screening were used to determine which farm practices, environmental factors, and calf health measures were associated with O157 detection. Multilevel logistic models, controlling for dairy operation, were created using backward elimination of screened variables. The final O157 main effects model included variables for source of colostrum, temperature-humidity index (THI), and serum IgG concentration. Higher serum IgG was associated with lower odds of O157 shedding, whereas calves fed colostrum from their own dam had higher odds of O157 shedding than calves fed colostrum from pooled sources. Interaction models showed that THI level modified the effect of colostrum source on O157 shedding; calves with a THI indicative of heat stress had a significantly increased presence of O157 when fed colostrum from a first-lactation dam. The THI level also modified the effects of serum IgG. Calves with thermoneutral or heat stress THI values had increased presence of O157 with poor (<10 g/L) or adequate (10-15 g/L) serum IgG levels compared with those having excellent (≥15 g/L) serum IgG levels. These results highlight factors that influence the presence of O157 in preweaned dairy heifer calves and may be used to guide practices that mitigate shedding through improved animal husbandry.

Preweaned heifer management on US dairy operations: Part II. Factors associated with colostrum quality and passive transfer status of dairy heifer calves.

Passive transfer of immunity is essential for the short- and long-term health of dairy calves. The objective of this study was to evaluate factors associated with colostrum quality and passive transfer status of US heifer calves. This study included 104 operations in 13 states that participated in the calf component of the National Animal Health Monitoring System's Dairy 2014 study. This 18-mo longitudinal study included 1,972 Holstein heifer calves from birth to weaning. Multivariable mixed linear regression models were selected using backward elimination model selection after univariate screening to determine which factors were associated with colostrum IgG and serum IgG concentrations. The mean colostrum IgG concentration was 74.4 g/L with 77.4% of colostrum samples having IgG concentrations >50 g/L. The final model for colostrum IgG included colostrum source and a categorized temperature-humidity index value (cTHI) for the month before calving. Mean colostrum IgG concentrations were highest for dams in third and higher lactations (84.7 g/L) and lowest for commercial colostrum replacers (40.3 g/L). Colostrum IgG concentrations were highest for cTHI ≥70 (72.6 g/L) and lowest for cTHI <40 (64.2 g/L). The mean serum IgG concentration was 21.6 g/L, with 73.3% of calves having serum IgG concentrations >15 g/L. The final model for serum IgG concentration included region, heat treatment of colostrum, colostrum source, timing to first feeding, volume of colostrum fed in the first 24 h, age of the calf at blood sampling, and colostrum IgG concentration. Mean serum IgG concentrations were highest for calves that received colostrum from first-lactation dams (25.7 g/L) and lowest for calves fed commercial colostrum replacer (16.6 g/L). Serum IgG concentrations were higher for calves fed heat-treated colostrum (24.4 g/L) than for calves fed untreated colostrum (20.5 g/L). Serum IgG concentration was positively associated with the volume of colostrum fed in the first 24 h and colostrum IgG concentration, and negatively associated with the number of hours from birth to colostrum feeding and age (days) at blood collection. Dairy producers should be encouraged to measure the quality of colostrum before administering it to calves and to measure serum IgG or a proxy such as serum total protein or Brix to evaluate passive immunity and colostrum management programs.

Preweaned heifer management on US dairy operations: Part I. Descriptive characteristics of preweaned heifer raising practices.

The objective of this study was to describe preweaned dairy heifer calf management practices on dairy operations across the United States that were used to analyze factors associated with colostrum quality and passive transfer, Cryptosporidium and Giardia, morbidity and mortality, and average daily gain. This study included 104 dairy operations in 13 states that participated in the National Animal Health Monitoring System's Dairy 2014 calf component study. This 18-mo longitudinal study focused on dairy heifer calves from birth to weaning, and data were collected on 2,545 heifer calves. Descriptive statistics were generated regarding colostrum feeding, preweaning housing, milk feeding and consumption, growth, morbidity and mortality, and weaning practices. The majority of calves enrolled were Holsteins (89.4%). Over half the calves (63.2%) enrolled in the study received the majority of their colostrum via bottle; however, 22.1% of calves from 51.0% of operations received colostrum via suckling from their dams. For all calves, the mean time to the first colostrum feeding was 2.8 h, and the average amount of colostrum at the first feeding was 2.9 L, with 4.5 L provided in the first 24 h. The mean serum IgG of all calves was 21.7 g/L; however, 76.0% of operations had at least 1 calf with failure of passive transfer of immunity with a serum IgG below 10 g/L. The majority of calves in the study were housed individually (86.6%). Nonetheless, 20.2% of operations housed some calves in groups, representing 13.4% of all calves. Approximately one-half of the calves in the study (52.3%) were dehorned or disbudded during the preweaning period, with only 27.8% of these calves receiving analgesics or anesthetics during the procedure. Whole or waste milk was the liquid diet type fed to 40.1% of calves, and milk replacer was fed to 34.8% of calves. A combination of milk and milk replacer was fed to 25.1% of calves. Calves, on average, were fed 2.6 L per feeding and fed 2.6 times/d, resulting in a total of 5.6 L of liquid diet fed per day. The mean average daily gain for all calves enrolled in the study was 0.7 kg/d. Fecal samples were collected and almost all operations had at least 1 calf positive for Cryptosporidium (94.2%) or Giardia (99.0%), and 84.6% of operations had calves that tested positive for both Cryptosporidium and Giardia. Over one-third of calves (38.1%) had at least one morbidity event during the preweaning period and the mortality rate was 5.0%. The mean age at weaning was 65.7 d. This study provides an update on dairy heifer raising practices in the United States.

Preweaned heifer management on US dairy operations: Part VI. Factors associated with average daily gain in preweaned dairy heifer calves.

The study objective was to evaluate average daily gain (ADG) in dairy heifer calves based on health, feeding, management practices, and environmental factors. This study included 102 operations in 13 states that participated in the calf component of the National Animal Health Monitoring System's Dairy 2014 study. This 18-mo longitudinal study included 1,410 Holstein heifer calves monitored from birth to weaning. The mean ADG from birth to final weight was 0.74 kg/d. Backward elimination model selection in Proc Mixed after univariate screening determined factors that significantly affected ADG. The final model included dam lactation number, singleton versus twin birth, bedding type, Giardia and Cryptosporidium fecal shedding, disease events, a categorized average temperature-humidity index for the preweaning period (pTHI), amount of protein in the liquid diet (kg/d), milk pasteurization, direct-fed microbials, and the interaction between milk pasteurization and direct-fed microbials. After controlling for other independent variables in the model, calves born to first-lactation dams gained less (0.60 kg/d) than calves from second- (0.65 kg/d) or third- or greater-lactation (0.64 kg/d) dams. Singleton calves gained 0.07 kg/d more than twins. Calves bedded with sand or no bedding gained less (0.49 kg/d) than calves on all other bedding types. Calves negative for Cryptosporidium or Giardia at the time of sampling gained 0.03 or 0.02 kg/d more, respectively, than calves that were positive for Cryptosporidium or Giardia. Calves with no disease events gained 0.07 kg/d more than calves with one or more disease events. Calves experiencing an average pTHI <50 gained more (0.67 kg/d) than calves experiencing an average pTHI from 50 to 69 (0.62 kg/d), or ≥70 (0.59 kg/d). Within the range of observed kilograms of protein fed per day in the liquid diet, every additional 0.1 kg of protein fed per day equated to 0.02 kg/d of gain. Calves fed milk replacer with a direct-fed microbial gained less (0.44 kg/d) than calves fed milk replacer without a direct-fed microbial (0.60 kg/d) and calves fed pasteurized or unpasteurized milk regardless of direct-fed microbial use. These results highlight the importance of feeding a quantity and quality of a liquid diet to achieve optimal growth, keeping calves free of disease, the type or status of bedding, and mitigating the effects of temperature and humidity on preweaning ADG.

Preweaned heifer management on US dairy operations: Part V. Factors associated with morbidity and mortality in preweaned dairy heifer calves.

The objective of this study was to evaluate morbidity and mortality in preweaned dairy heifer calves based on different health, feeding, and management practices, as well as environmental factors. This study was conducted as part of the calf component of the National Animal Health Monitoring System's Dairy 2014 study, which included 104 dairy operations in 13 states. The calf component was an 18-mo longitudinal study focused on dairy heifer calves from birth to weaning; data were collected on 2,545 calves. The percentage morbidity for all calves enrolled in the study was 33.9%. Backward elimination model selection was used after univariate screening to determine which management practices and environmental factors significantly affected morbidity and mortality. The final morbidity model included birth weight, serum IgG concentration, ventilation type, and average temperature-humidity index (THI) during the preweaning period. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower predicted risk of morbidity than calves with a lower birth weight. An increase in serum IgG concentration was associated with decreased morbidity. Calves housed in positive- or cross-ventilated systems had a 2.2 times higher odds of developing disease compared with calves housed in natural ventilation systems. Average THI during the preweaning period was inversely correlated with morbidity; as THI increased, the predicted morbidity risk decreased. The percent mortality for all calves enrolled in the study was 5.0%. The final mortality model included birth weight, serum IgG concentration, amount of fat/day in the liquid diet, and morbidity. After controlling for other independent variables in the model, calves born at a higher birth weight had a lower risk of mortality. An increase in serum IgG concentration decreased the risk of mortality. The odds of mortality were 3.1 times higher in calves fed ≤0.15 kg of fat/d in the liquid diet compared with calves fed ≥0.22 kg of fat/d. The odds of mortality were 4.7 times higher in calves that experienced any disease throughout the preweaning period than in calves with no disease. In summary, morbidity and mortality were both associated with birth weight and serum IgG concentration. Additionally, morbidity was associated with ventilation type and average monthly THI, and mortality was associated with amount of fat per day in the liquid diet and morbidity.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

Associations between housing and management practices and the prevalence of lameness, hock lesions, and thin cows on US dairy operations.

The objective of this study was to determine the association among different housing and management practices on the prevalence of lameness, hock lesions, and thin cows on US dairy operations. This study was conducted as part of the National Animal Health Monitoring System's Dairy 2014 study, which included dairy operations in 17 states. Size categories were assigned as follows: small (30-99 cows), medium (100-499 cows), and large (≥500 cows). Trained assessors visited 191 dairy operations from March through July 2014 and recorded locomotion and hock scores (on a 3-point scale), and the number of thin cows (body condition score ≤2.25) from a total of 22,622 cows (average 118 cows per farm). The majority of cows (90.4%) were considered to be sound (locomotion score = 1), 6.9% were mild/moderately lame (locomotion score = 2), and 2.7% were severely lame (locomotion score = 3). Similarly, most cows (87.3%) had no hock lesions (hock score = 1), 10.1% had mild lesions (hock score = 2), and 2.6% had severe hock lesions (hock score = 3). A low percentage of cows (4.2%) were thin. Univariate comparisons were performed using PROC LOGLINK, which accounts for study design and weighting. Variables meeting the univariate screening criterion of P < 0.20 were eligible for entry into multivariable models. Statistical significance in the multivariable models was declared at P < 0.05. Large operations had a lower within-herd prevalence of cows with locomotion score ≥2 and locomotion score = 3 compared with small or medium-sized operations. Operations on which cows were kept primarily on pasture had a lower percentage of locomotion score = 3 than those housed in freestall or open/dry lot operations. The use of sand bedding was associated with a lower within-herd prevalence of locomotion score ≥2 than straw/hay or dry/composted manure as the primary bedding material. Sand bedding was also associated with a lower within-herd prevalence of locomotion score = 3 than other bedding types except for rubber mats or mattresses. Operations that housed cows in an open/dry lot had a lower percentage of hock score ≥2 and hock score = 3 than other housing types. Providing sprinklers for heat abatement and having a nutritionist balance rations for cows was associated with a lower percentage of thin cows. Results from this study highlight management practices that may reduce the prevalence of lameness, hock lesions, and thin cows on dairy operations in the United States.

Comparison of healthcare priorities in childhood and early/late adolescence: analysis of cross-sectional data from eight countries in the Council of Europe Child-friendly Healthcare Survey, 2011.

AIMS: To investigate healthcare priorities among children (≤ 12 years), early adolescents (13-15 years) and late adolescents (16-18 years). METHODS: A total of 2023 respondents from eight European countries rated the importance of nine healthcare factors. The relative importance of these factors was compared within and between age groups, using mean score differences and logistic regression. RESULTS: The most important item for all age groups was being listened to. Children rated pain control and the presence of parents more important than either understanding the doctor or being able to ask questions. Among adolescents, these differences disappeared for pain control and were reversed for parental presence. The changes in relative priorities between childhood and adolescence remained significant after adjusting for sex, long-standing illness and nationality (all P < 0.001). CONCLUSION: Healthcare priorities evolve significantly between childhood and early adolescence. However, being listened to is the most important priority at all ages.

Longitudinal Impacts of Precision Greenness on Alzheimer's Disease.

BACKGROUND: The potential for greenness as a novel protective factor for Alzheimer's disease (AD) requires further exploration. OBJECTIVES: This study assesses prospectively and longitudinally the association between precision greenness - greenness measured at the micro-environmental level, defined as the Census block - and AD incidence. DESIGN: Older adults living in consistently high greenness Census blocks across 2011 and 2016 were compared to those living in consistently low greenness blocks on AD incidence during 2012-2016. SETTING: Miami-Dade County, Florida, USA. PARTICIPANTS: 230,738 U.S. Medicare beneficiaries. MEASUREMENTS: U.S. Centers for Medicare and Medicaid Services Chronic Condition Algorithm for AD based on ICD-9 codes, Normalized Difference Vegetation Index, age, sex, race/ethnicity, neighborhood income, and walkability. RESULTS: Older adults living in the consistently high greenness tertile, compared to those in the consistently low greenness tertile, had 16% lower odds of AD incidence (OR=0.84, 95% CI: 0.76-0.94, p=0.0014), adjusting for age, sex, race/ethnicity, and neighborhood income. Age, neighborhood income and walkability moderated greenness' relationship to odds of AD incidence, such that younger ages (65-74), lower-income, and non-car dependent neighborhoods may benefit most from high greenness. CONCLUSIONS: High greenness, compared to low greenness, is associated with lower 5-year AD incidence. Residents who are younger and/or who reside in lower-income, walkable neighborhoods may benefit the most from high greenness. These findings suggest that consistently high greenness at the Census block-level, may be associated with reduced odds of AD incidence at a population level.

High-salt diet and hypertension: focus on the renin-angiotensin system.

A high-salt diet is one of the major risk factors in the development and maintenance of hypertension. Numerous experimental and observational studies have confirmed the association of sodium intake with blood pressure levels. The effects of a high-salt diet are related to the function of the renin-angiotensin system, which is normally suppressed by a high-salt diet. Endothelial dysfunction probably plays an important role in the influence of high sodium intake on blood pressure, although the exact mechanisms remain elusive. Genetic factors are known to be very important, and various consomic and congenic rat strains as animal models have proven to be very useful in bringing us a step closer to understanding the interaction between salt intake and hypertension. In this article, experimental data obtained in studies on animals and humans, as well as epidemiological data are reviewed.

Prevalence, species distribution and antimicrobial resistance of enterococci isolated from US dairy cattle.

AIMS: To estimate prevalence and antimicrobial susceptibility of enterococci in faeces collected in 2007 from U.S. dairy cattle. METHODS AND RESULTS: A total of 718 faecal samples from 122 dairy cattle operations from 17 US States were collected and cultured for the presence of enterococci. One hundred and eighteen of the 122 operations (96·7%) had at least one dairy cow positive for enterococci and 88·7% (637 of 718) of the faecal samples were positive. At least ten different enterococcal species were found on the dairy operations and 90·7% (107 of 118) of the operations were positive for Enterococcus hirae followed by E. faecalis (40·7%; 48 of 118) and E. faecium (39%; 46 of 118). The highest percentage of resistant isolates were to lincomycin (92·3%; 587 of 636), flavomycin (71·9%; 457 of 636) and tetracycline (24·5%; 156 of 636). Multi-drug resistance (MDR) (resistance ≥ 2 antimicrobials) was observed to as many as seven antimicrobials regardless of class. CONCLUSION: In contrast to previous studies, faecal shedding of enterococci in dairy cattle occurred in almost 90% of cows sampled and represented a variety of enterococcal species. SIGNIFICANCE AND IMPACT OF STUDY: Although this study demonstrated a high prevalence of antimicrobial-resistant enterococci from dairy cattle faeces in the United States, the contribution of dairy cattle as a source of antimicrobial-resistant enterococci that can be transmitted to humans remains unclear.

Consequence of alternative standards for bulk tank somatic cell count of dairy herds in the United States.

Noncompliance with current US and European Union (EU) standards for bulk-tank somatic cell count (BTSCC) as well as BTSCC standards recently proposed by 3 US organizations was evaluated using US Dairy Herd Improvement Association (DHI) herds and herds supplying milk to 4 Federal Milk Marketing Orders (FMO). Herds with 15 to 26 tests (frequently monthly) from January 2009 through October 2010 were included. Somatic cell scores (SCS) from 14,854 herds and 164,794 herd-tests were analyzed for DHI herds with ≥10 cows for all tests. Herd test-day SCC was derived as a proxy for BTSCC and was the basis for determining noncompliance and percentage of the milk it represented. For FMO herds, actual milk marketed and BTSCC were available from 27,759 herds and 325,690 herd-tests. A herd was noncompliant for the current EU BTSCC standard after 4 consecutive rolling 3-test geometric means (geometric method) were >400,000 cells/mL. A herd was noncompliant for the current US BTSCC standard after 3 of 5 consecutive monthly BTSCC shipments (frequency method) were >750,000 cells/mL. Alternative proposed standards (600,000, 500,000, or 400,000 cells/mL) also were examined. A third method designated noncompliance when a single 3-mo geometric mean of >550,000 or >400,000 cells/mL and a subsequent test exceeded the same level. Results were examined based on herd size or milk shipped by month. Noncompliance for the current US standard for the 12 mo ending October 2010 in DHI and FMO herds was 0.9 and 1.0%, respectively, compared with 7.8 and 16.1% for the current EU standard. Noncompliance was always greater for the frequency method than for the geometric method and was inversely related to herd size or milk shipped. Using the frequency method at 400,000 cells/mL, noncompliance was 19.1% for DHI herd-tests in herds with <50 cows compared with 1.1% for herds with ≥ 1,000 cows. For FMO herds shipping <900 t, noncompliance was 44.5% using the frequency method at 400,000 cells/mL compared with 8.0% for herds marketing >9,000 t. All methods proposed increased the percentages of herds and shipped milk that exceeded the regulatory limit. Producers will need to place more emphasis on reducing the incidence and prevalence of subclinical mastitis through known management practices such as proper milking techniques, well-functioning milking machines, postmilking teat disinfectant, dry cow treatment, and culling of problem cows to meet any of the proposed new standards.

Lying and stepping behaviors around corrective or therapeutic claw trimming.

The objectives of this study were to test differences in lying and stepping behaviors in lactating cows with altered gait or other signs of pain in the day preceding either corrective claw trimming (CCT) or therapeutic claw trimming (TCT; d -1), including healthy controls (HC) as a reference group, and to analyze the associations between categories of lying and stepping behaviors at d -1 and subsequent submission to CCT or TCT (d 0). In addition, we characterized variations in lying and stepping behaviors within 7 d relative to CCT or treatment for a specific foot condition (TCT). A total of 310 Holstein cows in a USDA-certified organic dairy herd in northern Colorado were enrolled. Cows were affixed with an accelerometer (IceQube, IceRobotics) below the fetlock of one hind leg at 12 ± 8 d in milk and monitored for 6 mo for daily activity [lying time (LY; min/d), lying bouts (LB; no./d), and steps (ST; no./d)]. Cows with altered gait or other signs of pain were submitted to claw trimming (CT; d 0) and differentiated as receiving only corrective interventions (CCT) or as being treated for a lameness disorder (TCT). Concurrent activity from cows not submitted to CT was considered a reference from HC. Daily averages for each activity within ±7 d relative to CT were compared among the 3 groups using linear mixed models (PROC MIXED of SAS; SAS Institute Inc.). Logistic regression analyses with a logit link function (PROC GLIMMIX of SAS) were used to test the associations between categories (lower quartile or less, interquartile range, and higher quartile or greater) of lying and stepping behaviors (LY, LB, and ST) preceding CT (d -1) and subsequent submission to CCT or TCT (d 0). On d -1, average (± standard error) LY was greater in TCT (631 ± 34 min/d) than in CCT (568 ± 22 min/d) and HC (581 ± 13 min/d). Overall, LB were not statistically different among groups (CCT = 18.7 ± 0.02 bouts/d; TCT = 19.6 ± 1.17 bouts/d; and HC = 19.1 ± 0.43 bouts/d). Daily ST were lower in TCT (1,810 ± 126 steps/d) than in CCT (2,803 ± 63 steps/d) and HC (2,542 ± 103 steps/d). The odds (confidence interval in parentheses) of TCT were greater in cows in the high LY [3.27 (2.47-4.33)] and high LB [2.31 (1.77-3.02)] categories at d -1. The low ST category was associated with increased odds of CCT [3.32 (1.96-5.65)] and TCT [8.48 (6.49-11.1)]. We concluded that, under the current experimental conditions, cows requiring TCT evidenced greater overall LY and lower daily ST the day before CT. However, these differences were not consistent throughout days in milk categories within the lactation. Type of CT was partially associated with category of activity the day preceding CT, and the associations were more evident for TCT. The magnitude of the behavioral changes before and after CT and the recovery times posttreatment to approach HC behavioral levels varied depending on specific conditions.