An epidemiological study of diabetes mellitus in dogs attending first opinion practice in the UK

This study aimed to estimate the prevalence of canine diabetes mellitus (DM) in primary-care clinics in England, to identify risk factors associated with DM and to describe the survival of affected dogs. Cases of DM were identified within the electronic patient records of 89 small-animal practices. A nested case–control study identified risk factors for the diagnosis of DM using logistic regression models. Cox proportional hazards models were used to analyse variables associated with survival. Four-hundred and thirty-nine canine DM cases were identified, giving an apparent prevalence of 0.34% (95% CI 0.31% to 0.37%). Neutered males were at an increased risk of diabetes compared with entire males, whereas neutering was not associated with DM in females. When compared with crossbred dogs, Yorkshire terriers had increased odds, whereas German shepherd dogs and golden retrievers had lower odds of DM. Being classified as overweight and having a diagnosis of pancreatitis, hyperadrenocorticism or a urinary tract infection were positively associated with DM. Older dogs and those diagnosed with pancreatitis had a higher hazard of death, whereas insured and neutered dogs had a lower hazard. This study provides an objective assessment of canine DM using primary-care veterinary practice data and is a valuable benchmark against which future epidemiological trends in DM can be assessed and improvements in the management of DM in primary-care practice can be judged

Is serum phosphorus control related to parathyroid hormone control in dialysis patients with secondary hyperparathyroidism?

Background Elevated serum phosphorus (P) levels have been linked to increased morbidity and mortality in dialysis patients with secondary hyperparathyroidism (SHPT) but may be difficult to control if parathyroid hormone (PTH) is persistently elevated. We conducted a post hoc analysis of data from an earlier interventional study (OPTIMA) to explore the relationship between PTH control and serum P. Methods The OPTIMA study randomized dialysis patients with intact PTH (iPTH) 300–799 pg/mL to receive conventional care alone (vitamin D and/or phosphate binders [PB]; n = 184) or a cinacalcet-based regimen (n = 368). For patients randomized to conventional care, investigators were allowed flexibility in using a non-cinacalcet regimen (with no specific criteria for vitamin D analogue dosage) to attain KDOQI™ targets for iPTH, P, Ca and Ca x P. For those assigned to the cinacalcet-based regimen, dosages of cinacalcet, vitamin D sterols, and PB were optimized over the first 16 weeks of the study, using a predefined treatment algorithm. The present analysis examined achievement of serum P targets (≤4.5 and ≤5.5 mg/dL) in relation to achievement of iPTH ≤300 pg/mL during the efficacy assessment phase (EAP; weeks 17–23). Results Patients who achieved iPTH ≤ 300 pg/mL (or a reduction of ≥30% from baseline) were more likely to achieve serum P targets than those who did not, regardless of treatment group. Of those who did achieve iPTH ≤ 300 pg/mL, 43% achieved P ≤4.5 mg/dL and 70% achieved P ≤5.5 mg/dL, versus 21% and 46% of those who did not achieve iPTH ≤ 300 pg/mL. Doses of PB tended to be higher in patients not achieving serum P targets. Patients receiving cinacalcet were more likely to achieve iPTH ≤300 pg/mL than those receiving conventional care (73% vs 23% of patients). Logistic regression analysis identified lower baseline P, no PB use at baseline and cinacalcet treatment to be predictors of achieving P ≤4.5 mg/dL during EAP in patients above this threshold at baseline. Conclusions This post hoc analysis found that control of serum P in dialysis patients was better when serum PTH levels were lowered effectively, regardless of treatment received

An epidemiological study of diabetes mellitus in dogs attending first opinion practice in the UK

Objectives: To estimate the prevalence of canine diabetes mellitus (DM) in primarycare clinics in England, to identify risk factors associated with DM and to describe the survival of affected dogs. Methods: Cases of DM were identified within the electronic patient records of 89 small-animal practices. A nested case-control study identified risk factors for the diagnosis of DM using logistic regression models. Cox proportional hazards models were used to analyse variables associated with survival. Results: Four-hundred and thirty-nine canine DM cases were identified, giving an apparent prevalence of 0.34% (95% confidence interval 0.31 - 0.37%). Neutered males were at an increased risk of diabetes compared to entire males, whereas neutering was not associated with DM in females. Compared with crossbred dogs, Yorkshire terriers had increased odds, whereas German shepherd dogs and golden retrievers had lower odds of DM. Being classified as overweight and having a diagnosis of pancreatitis, hyperadrenocorticism or a urinary tract infection were positively associated with DM. Older dogs and those diagnosed with pancreatitis had a higher hazard of death, whereas insured and neutered dogs had a lower hazard. Clinical significance: This study provides an objective assessment of canine DM using primary-care veterinary practice data and is a valuable benchmark against which future epidemiological trends in DM can be assessed and improvements in the management of DM in primary-care practice can be judged

Understanding the Implications of Alternative Bioenergy Crops to Support Smallholder Farmers in Brazil

Smallholders constitute more than three quarters of the world’s farmers, and despite their numbers, they commonly lack opportunities to advance their development status. Bioenergy production and consumption can help sustain smallholders’ energy needs and generate employment and income, but it also raises concerns over social justice and equity, especially where crops used for bioenergy could also be used for food. This perspective paper is grounded in a literature review related to three different crops in Brazil: sugarcane, landrace maize and sweet potato. It seeks to determine if these crops offer the potential to support smallholder farmers’ development in a more equitable way, focusing on opportunities for their use in bioenergy. We review the literature to identify policies shaping the smallholder development context in relation to these crops, assessing whose knowledge informs policy and institutional decision making, and highlighting the policy attention afforded to the different crops from different sectors. We further evaluate the literature on each crop in relation to water use and calorific value (i.e., food and energy). Our review indicates that while sugarcane has received the most policy and institutional attention, its development is largely anchored in research and development investments that support large-scale commercial farms and agri-businesses. Smallholders have not benefited or had the opportunity to engage in relevant policy decision making for sugarcane cultivation. At the same time, smallholders hold valuable untapped knowledge on the cultivation of sweet potato and landrace maize, both of which have the potential to generate development opportunities for smallholders. Our review suggests that the environmental impact of landrace maize and sweet potato in terms of water use is significantly lower than sugarcane, while they can generate more calories for energy or food consumption and offer diversification opportunities. Despite that these alternative crops offer considerable untapped potential to support rural development, more research is still needed to harness these benefits. Changes are needed to address inequities in policies, institutions and the types of knowledge informing decision making. Such changes need to afford smallholder farmers greater recognition and participation in decision making, so that the distribution of benefits from the three study crops can reach them to support their development better

Border Terriers under primary veterinary care in England: demography and disorders

The Border Terrier is a working terrier type that is generally considered to be a relatively healthy and hardy breed. This study aimed to characterise the demography and common disorders of Border Terriers receiving veterinary care in England using de-identified electronic patient record data within the VetCompass™ Programme

Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival

Background: Diabetes mellitus (DM) is an important endocrine disorder of dogs. The objectives of this study were to estimate prevalence and incidence of DM in dogs, and to explore risk factors for DM and the survival of DM cases in primary-care clinics in the UK. Results: A case-control study nested in the cohort of dogs (n = 480,469) aged ≥3 years presenting at 430 VetCompass clinics was used to identify risk factors for DM, using multivariable logistic regression. Overall 409 new and 863 pre-existing DM cases (total 1272) were identified in 2016, giving an apparent annual prevalence of 0.26% (95% confidence interval (CI): 0.25–0.28%), and an annual incidence risk of 0.09% (95%CI: 0.08–0.09%) in dogs aged ≥3 years. Factors associated with increased odds for DM diagnosis were all age categories > 8 years, female entire dogs (odds ratio (OR): 3.03, 95% CI 1.69–5.44, p < 0.001) and male neutered dogs (OR: 1.99, 95% CI 1.18–3.34, p = 0.010) compared to male entire dogs, Border Terriers (OR: 3.37, 95% CI 1.04–10.98, p = 0.043) and West Highland White Terriers (WHWT) (OR: 2.88, 95% CI 1.49–5.56, p = 0.002) compared to crossbreeds. Dogs that had received previous glucocorticoid treatment (OR: 2.19, 95% CI 1.02–4.70, p = 0.044) and those with concurrent conditions (documented obese, pancreatitis, hyperadrenocorticism) also had increased odds for DM diagnosis. Cox regression modelling was used to evaluate factors associated with survival in the 409 incident DM cases in 2016. Increased hazard of death following diagnosis of DM was shown in dogs that were ≥ 10 years age, Cocker Spaniels (HR: 2.06, 95% CI 1.06–4.01, p = 0.034) compared to crossbreeds, had a blood glucose (BG) level at diagnosis > 40 mmol/L (HR: 2.73, 95% CI 1.35–5.55, p = 0.005) compared to < 20 mmol/L at diagnosis, or had received previous glucocorticoid treatment (HR: 1.86, 95% CI 1.21–2.86, p = 0.005). Dogs at reduced hazard of death included neutered dogs (HR: 0.58, 95% CI 0.42–0.79, p = 0.001), Border Collies (HR: 0.39, 95% CI 0.17–0.87, p = 0.022) and those starting insulin treatment (HR: 0.08 95% CI 0.05–0.12, p < 0.001). Conclusions: Certain breeds and concurrent health conditions are associated with an increased risk of DM. In addition to certain signalment factors, a high BG level at diagnosis and prior glucocorticoid treatment were adversely associated with survival of dogs with DM. Keywords: Diabetes mellitus, Risk factors, Survival, Case-control study, Benchmarking, VetCompas

Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management

Abstract Background Corneal ulcerative disease (CUD) has the potential to adversely affect animal welfare by interfering with vision and causing pain. The study aimed to investigate for the first time the prevalence, breed-based risk factors and clinical management of CUD in the general population of dogs under primary veterinary care in England. Results Of 104,233 dogs attending 110 clinics participating within the VetCompass Programme from January 1st to December 31st 2013, there were 834 confirmed CUD cases (prevalence: 0.80%, 95% confidence interval (CI) 0.75–0.86). Breeds with the highest prevalence included Pug (5.42% of the breed affected), Boxer (4.98%), Shih Tzu (3.45%), Cavalier King Charles Spaniel (2.49%) and Bulldog (2.41%). Purebred dogs had 2.23 times the odds (95% CI 1.84–2.87, P < 0.001) of CUD compared with crossbreds. Brachycephalic types had 11.18 (95% CI 8.72–14.32, P < 0.001) and spaniel types had 3.13 (95% CI 2.38–4.12, P < 0.001) times the odds for CUD compared with crossbreds. Pain was recorded in 385 (46.2%) cases and analgesia was used in 455 (54.6%) of dogs. Overall, 62 (7.4%) cases were referred for advanced management and CUD contributed to the euthanasia decision for 10 dogs. Conclusions Breeds such as the Pug and Boxer, and conformational types such as brachycephalic and spaniels, demonstrated predisposition to CUD in the general canine population. These results suggest that breeding focus on periocular conformation in predisposed breeds should be considered in order to reduce corneal disease

A National Study Comparing Baldrige Core Values and Concepts with AACN Indicators of Quality: Facilitating CCNE-Baccalaureate Colleges of Nursing Move toward More Effective Continuous Performance Improvement Practices

The AACN has asked academic leaders to align the performance of their organizations to the prescribed standards within the Essentials of Baccalaureate Education for Professional Nursing Practice document and has provided indicators of quality suggestions for program enhancement as a means of promoting continuous performance improvement. However, the AACN has not prescribed a strategy that specifies the manner in which colleges should achieve these benchmarked standards, which has created uncertainty among administrators about whether the indicators of quality lead to improvements that are actually indicative of improved performance. This dissertation used multiple linear regression research design to determine whether predictive relationships exist between the American Association of Colleges of Nursing (AACN) indicators of quality and the Baldrige core values and concepts of performance improvement within Commission on Collegiate Nursing Education accredited baccalaureate colleges of nursing. The purpose of this study was to determine whether the behaviors associated with specific AACN indicators of quality reflect behaviors that the Baldrige core values and concepts have already proven to be successful in achieving continuous performance improvement. The results revealed nine AACN indicators of quality behaviors most likely to enhance performance improvement outcomes within baccalaureate colleges of nursing. They include; (1) Resources are budgeted for research, development, business operations, public relations, marketing, and human resources; (2) Establishing and upholding policies that reflect faculty and leadership development resources; (3) Student experiences include service learning opportunities; (4) Practice partnerships include collaborative practice initiatives; (5) Collecting data and making program changes that focus on the level of graduate satisfaction with their preparation for the profession; (6) Faculty have input into the governance of the college/school; (7) The majority of faculty have a presence in state, regional, national, and international professional activities; (8) Opportunities for baccalaureate graduate's employment with practice partnerships; and (9) Formal mentoring program for clinical preceptors. The results underline the fact that continuous performance improvement within baccalaureate colleges of nursing is a deliberate and dynamic analysis-driven endeavor dependent on an organization's ability, willingness, and initiative to continually strive to narrow the chasm between actual and potential performance results