The Effect of Basal Diet on Lactate-Producing Bacteria and the Susceptibility of Sheep to Lactic Acidosis

The influence of a diet of either pasture or hay on the development of lactic acidosis in sheep was investigated using a grain challenge approach. Twenty-four Merino wethers with a mean live weight of 36.7 (s.e. 3.6) kg were used; 12 were adapted to grass pasture and 12 to hay (lucerne and oaten hay, 60 : 40) for 4 weeks before being given 1 kg of crushed barley via stomach tube. Six sheep in each group were also given virginiamycin (VM; 50 mg/kg barley) with the grain to test the efficacy of this antibiotic in controlling the bacteria responsible for the development of acidosis. Changes in volatile fatty acid (VFA), pH, lactate and bacterial count in the rumen and faecal pH and dry matter (DM) were measured for a 24-h period following administration of the barley. Daily intakes of hay were measured for a 10-day period following grain engorgement. Total ruminal VFA increased (P < 0.01) over time and tended (P = 0.08) to be higher in sheep adapted to hay than in those adapted to pasture (67.5 v. 59.8 mmol/l). The molar proportions of VFA changed (P< 0.01) over time in favour of propionate in both groups. Ruminal pH was higher (P< 0.001) in pasture-adapted sheep, but declined (P< 0.001) in both groups over time following the introduction of barley. This decline in pH was associated with increases in ruminal concentration of VFA in pasture-adapted sheep and VFA and lactate in hay-adapted sheep. The addition of VM resulted in a higher (P < 0.001) proportion of propionate and a trend towards higher (P = 0.24) faecal pH and DM content. Faecal pH and DM content declined (P < 0.001) over time and was lower for the pasture-adapted sheep. The introduction of either barley alone or barley with VM from both hay and pasture diets increased (P < 0.05) the viable counts of total bacteria, Streptococcus bovis and lactic acid bacteria. Bacterial isolates were purified and identified by complete sequencing of the 16S rRNA gene to determine the predominant bacteria during the overfeeding of grain. Isolates from medium selective for S. bovis were all identified as this species when VM was not given. VM had no effect on counts of viable bacteria, but inhibited the growth of S. bovis

Health literacy of recently hospitalised patients: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

BackgroundHealth literacy is simply defined as an individual&rsquo;s ability to access, understand and use information in ways that promote and maintain good health. Lower health literacy has been found to be associated with increased emergency department presentations and potentially avoidable hospitalisations. This study aimed to determine the health literacy of hospital inpatients, and to examine if associations exist between different dimensions of their health literacy, sociodemographic characteristics and hospital services use.MethodsA written survey was sent to 3,252 people aged &ge;18 years in English, Arabic, Chinese, Vietnamese, Italian or Greek. The survey included demographic and health questions, and the Health Literacy Questionnaire (HLQ). The HLQ is a multidimensional instrument comprising nine independent scales. Use of hospital services was measured by length of stay, number of admissions in 12 months and number of emergency department presentations. Effect size (ES) for standardised differences in means described the magnitude of differences in HLQ scale scores between demographic and socioeconomic groups.Results385 questionnaires were returned (13%); mean age 64 years (SD 17), 49% female. Aged &ge;65 years (55%), using the Internet&thinsp;&lt;&thinsp;once a month (37%), failure to complete high school (67%), low household income (39%), receiving means-tested government benefits (61%) and being from a culturally and linguistically diverse (CALD) background (24%), were all associated with lower scores in some health literacy scales. Being aged &ge;65 years, not currently employed, receiving government benefits, and being from a CALD background were also associated with increased use of some hospital services. There was no association between lower scores on any HLQ scale and greater use of hospital services.ConclusionWe found no association between lower health literacy and greater use of hospital health services. However increased age, having a CALD background and not speaking English at home were all associated with having the most health literacy challenges Strategies to address these are needed to reduce health inequalities.<br /

Differences in health literacy profiles of patients admitted to a public and a private hospital in Melbourne, Australia

BackgroundHealth literacy refers to an individual&rsquo;s ability to find, understand and use health information in order to promote and maintain health. An individual&rsquo;s health literacy may also be influenced by the way health care organisations deliver care. The aim of this study was to investigate the influence of hospital service type (public versus private) on individual health literacy.MethodsTwo cross-sectional surveys were conducted using the Health Literacy Questionnaire (HLQ), a multi-dimensional self-report instrument covering nine health literacy domains. Recently discharged private patients (n&thinsp;=&thinsp;3121) were sent the survey in English, public patients (n&thinsp;=&thinsp;384) were sent the survey in English, Arabic, Chinese, Vietnamese, Italian or Greek. Eligibility included hospitalisation &ge;24 h in last 30 days, aged &ge;18 years, no cognitive impairment. Odds ratios were used to assess differences between hospital sociodemographic and health related variables. ANOVA and Cohen&rsquo;s effect sizes compared HLQ scores between hospitals. Chi square and multiple logistic regression were used to determine whether differences between private and public hospital HLQ scores was independent of hospital population sociodemographic differences. ANOVA was used to review associations between HLQ scores and subgroups of demographic, health behaviour and health conditions and these were then compared across the two hospital populations.ResultsPublic hospital participants scored lower than private hospital participants on eight of the nine health literacy domains of the HLQ (scores for Active Appraisal did not differ between the two samples). Six domains, five of which in part measure the impact of how care is delivered on health literacy, remained lower among public hospital participants after controlling for age, education, language and income. Across both hospital populations, participants who were smokers, those who had low physical activity, those with depression and/or anxiety and those with 3 or more chronic conditions reported lower scores on some HLQ domains.ConclusionsOur finding of lower health literacy among patients who had received care at a public hospital in comparison to a private hospital, even after adjustment for sociodemographic and language differences, suggests that private hospitals may possess organisational attributes (environment, structure, values, practices and/or workforce competencies) that result in improved health literacy responsiveness.<br /

Health literacy of recently hospitalised patients: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

BackgroundHealth literacy is simply defined as an individual&rsquo;s ability to access, understand and use information in ways that promote and maintain good health. Lower health literacy has been found to be associated with increased emergency department presentations and potentially avoidable hospitalisations. This study aimed to determine the health literacy of hospital inpatients, and to examine if associations exist between different dimensions of their health literacy, sociodemographic characteristics and hospital services use.MethodsA written survey was sent to 3,252 people aged &ge;18 years in English, Arabic, Chinese, Vietnamese, Italian or Greek. The survey included demographic and health questions, and the Health Literacy Questionnaire (HLQ). The HLQ is a multidimensional instrument comprising nine independent scales. Use of hospital services was measured by length of stay, number of admissions in 12 months and number of emergency department presentations. Effect size (ES) for standardised differences in means described the magnitude of differences in HLQ scale scores between demographic and socioeconomic groups.Results385 questionnaires were returned (13%); mean age 64 years (SD 17), 49% female. Aged &ge;65 years (55%), using the Internet&thinsp;&lt;&thinsp;once a month (37%), failure to complete high school (67%), low household income (39%), receiving means-tested government benefits (61%) and being from a culturally and linguistically diverse (CALD) background (24%), were all associated with lower scores in some health literacy scales. Being aged &ge;65 years, not currently employed, receiving government benefits, and being from a CALD background were also associated with increased use of some hospital services. There was no association between lower scores on any HLQ scale and greater use of hospital services.ConclusionWe found no association between lower health literacy and greater use of hospital health services. However increased age, having a CALD background and not speaking English at home were all associated with having the most health literacy challenges Strategies to address these are needed to reduce health inequalities.<br /

Public sector 'modernisation': examining the impact of a change agenda on local government employees in England

Can public sector reform change service performance for the better? This is a hotly contested debate which carries significant theoretical and practical importance. In England, as in many countries, modernisation was at the heart of local government reform and represented an interpretation of New Public Management into a policy framework. This paper examines the role of the modernisation change agenda in England and what this has subsequently meant for 'service improvement'. Drawing on both document analyses and qualitative interviews with local government employees, we find that while modernisation sought to establish continuous improvement, unintended consequences of modernisation have led to Staff Reductions, Skill Deficiencies, and Loss of a Competent Middle Core in local government, as well as performance outcomes creating an environment for Commissioning, Service Reduction, and Self-Policing. Implications for the lasting roles and behaviours of public managers affected by this national change agenda are discussed, and conclusions for theory and practice are drawn

Lapatinib plus Letrozole as First-Line Therapy for HER-2+ Hormone Receptor–Positive Metastatic Breast Cancer

Reported are results from a subgroup analysis of postmenopausal women with hormone receptor–positive human epidermal growth factor receptor 2–positive metastatic breast cancer from a phase III trial of letrozole plus placebo versus letrozole plus lapatinib. The combination was well tolerated and more efficacious than letrozole alone