Characterizing the attitudes and motivations of Ontario dairy producers toward udder health.

Considerable research has focused on identifying risk factors for intramammary infections, yet mastitis remains a pervasive disease on dairy farms. Increasingly, researchers are appreciating the role of dairy producer mindset in determining management style and thus udder health status of the herd. The objective of this study was to explore the attitudes and motivations of Ontario dairy farmers toward udder health in herds with varying bulk milk somatic cell count (BMSCC). In December 2011, 5 focus groups were conducted across Ontario, Canada, with independent groups of dairy producers representing low, medium, and high BMSCC herds. Groups were established based on producer's weighted BMSCC levels as recorded over the summer of 2011. A semi-structured interview guide was followed to discuss topics relating to udder health. Thematic analysis was performed on the interview transcripts. Generally, producers noted management techniques (specifically culling infected cows and monitoring BMSCC), a perceived wealth of information on mastitis control, and a proactive whole-herd management approach engender the perception of control over mastitis. Producers in the low BMSCC group were confident in their level of knowledge and control of mastitis in their herds, whereas high BMSCC producers generally felt lower levels of control. Several areas were identified by producers that counteract this perception, contributing to perceived low levels of control over mastitis. Participants identified that at certain times they do not understand the cause of BMSCC on their farm. This attitude was especially prominent in the high BMSCC group. Other times, producers cited improper sample handling, seasonal issues, perceived milk culture shortcomings, and low herd size as factors that limited their control over mastitis in their herds. Though producers generally have high levels of self-efficacy beliefs when it comes to udder health management, the perception still exists that, under certain situations, mastitis is uncontrollable. This highlights the fact that educational and extension efforts need to focus on ensuring that producers employ proven mastitis diagnostic, prevention, and treatment practices in a systematic manner, with realistic expectations.

Comparative efficacy of antimicrobials for treatment of clinical mastitis in lactating dairy cattle: a systematic review and network meta-analysis.

A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy for clinical mastitis in lactating dairy cattle. Controlled trials in lactating dairy cattle with natural disease exposure were eligible if they compared an antimicrobial treatment to a non-treated control, placebo, or a different antimicrobial, for the treatment of clinical mastitis, and assessed clinical or bacteriologic cure. Potential for bias was assessed using a modified Cochrane Risk of Bias 2.0 tool. From 14775 initially identified records, 54 trials were assessed as eligible. Networks were established for bacteriologic cure by bacterial species group, and clinical cure. Disparate networks among bacteriologic cures precluded meta-analysis. Network meta-analysis was conducted for trials assessing clinical cure, but lack of precision of point estimates resulted in wide credibility intervals for all treatments, with no definitive conclusions regarding relative efficacy. Consideration of network geometry can inform future research to increase the utility of current and previous work. Replication of intervention arms and consideration of connection to existing networks would improve the future ability to determine relative efficacy. Challenges in the evaluation of bias in primary research stemmed from a lack of reporting. Consideration of reporting guidelines would also improve the utility of future research.

Studying the relationship between on-farm environmental conditions and local meteorological station data during the summer.

High ambient heat and humidity have profound effects on the production, health, profitability, and welfare of dairy cattle. To describe the relationship between summer temperature and relative humidity in the barn and determine the appropriateness of using meteorological station data as a surrogate for on-farm environmental monitoring, a study was conducted on 48 farms in Ontario, Canada, over the summer (May through September) of 2013. Within-barn environmental conditions were recorded using remote data loggers. These values were compared with those of the closest official meteorological station. In addition, farm-level characteristics and heat-abatement strategies were recorded for each farm. Environmental readings within the barn were significantly higher than those of the closest meteorological station; however, this relationship varied greatly by herd. Daily temperature-humidity index (THI) values within the barn tended to be 1 unit higher than those of the closest meteorological station. Numerically, 1.5 times more mean daily THI readings were in excess of 68 (heat stress threshold for lactating dairy cows) in the barn, relative to the closest meteorological station. In addition, tiestalls, herds that were allowed access to pasture, and herds that had no permanent cooling strategy for their cows had the highest mean and maximum daily THI values. Minimum daily THI values were almost 4 units higher for tiestall relative to freestall herds. Overall, due to farm-specific and unpredictable variability in magnitude of environmental differences between on-farm and meteorological station readings, researchers attempting to study the effects of environment on dairy cows should not use readings from meteorological stations because these will often underestimate the level of heat stress to which cows are exposed.

Exploring the characteristics and dynamics of Ontario dairy herds experiencing increases in bulk milk somatic cell count during the summer.

Regionally aggregated bulk milk somatic cell count (BMSCC) data from around the world shows a repeatable cyclicity, with the highest levels experienced during warm, humid seasons. No studies have evaluated this seasonal phenomenon at the herd level. The objectives of this study were to define summer seasonality in BMSCC on an individual herd basis, and subsequently to describe the characteristics and dynamics of herds with increased BMSCC in the summer. The data used for this analysis were from all dairy farms in Ontario, Canada, between January 2000 and December 2011 (n≈4,000 to 6,000 herds/yr). Bulk milk data were obtained from the milk marketing board and consisted of bulk milk production, components (fat, protein, lactose, other solids), and quality (BMSCC, bacterial count, inhibitor presence, freezing point), total milk quota of the farm, and milk quota and incentive fill percentage. A time-series linear mixed model, with random slopes and intercepts, was constructed using sine and cosine terms as predictors to describe seasonality, with herd as a random effect. For each herd, seasonality was described with reference to 1 cosine function of variable amplitude and phase shift. The predicted months of maximal and minimal BMSCC were then calculated. Herds were assigned as low, medium, and high summer increase (LSI, MSI, and HSI, respectively) based on percentiles of amplitude in BMSCC change for each of the 4 seasons. Using these seasonality classifications, 2 transitional repeated measures logistic regression models were built to assess the characteristics of MSI and HSI herds, using LSI herds as controls. Based on the analyses performed, a history of summer BMSCC increases increased the odds of experiencing a subsequent increase. As herd size decreased, the odds of experiencing HSI to MSI in BMSCC increased. Herds with more variability in daily BMSCC were at higher odds of experiencing MSI and HSI in BMSCC, as were herds with lower annual mean BMSCC. Finally, a negative association was noted between filling herd production targets and experiencing MSI to HSI in BMSCC. These findings provide farm advisors direction for predicting herds likely to experience increases in SCC over the summer, allowing them to proactively focus udder health prevention strategies before the high-risk summer period.

Short communication: Bulk milk somatic cell penalties in herds enrolled in Dairy Herd Improvement programs.

The objective of this study was to determine the effect of somatic cell count (SCC) monitoring at the cow level through Dairy Herd Improvement (DHI) programs on the risk of bulk tank SCC (BTSCC) penalties. For the year 2009, BTSCC for all producers in Ontario were examined, for a total of 2,898 DHI herds, 1,186 non-DHI herds, and 48,250 BTSCC records. Two penalty levels were examined, where BTSCC exceeded 499,000 (P500) and 399,000 (P400) cells/mL. Data were modeled first to determine the odds of a BTSCC exceeding a set penalty threshold and second to determine the odds of incurring a penalty under the Ontario Milk Act. All data were modeled as a generalized mixed model with a binary link function. Random effects included herd, fixed effects included season of BTSCC (summer, May to September, and winter, October to April), total milk shipped per month (L), fat paid per month (kg), protein paid per month (kg), and participation or not in the DHI program. The likelihood of a BTSCC exceeding a penalty threshold in a non-DHI herd compared with a DHI herd was significantly greater than 1 at both penalty levels, where the odds ratios were estimated to be 1.42 [95% confidence interval (CI): 1.19 to 1.69] and 1.38 (95% CI: 1.25 to 1.54) for P500 and P400, respectively. The likelihood of incurring a BTSCC penalty (where 3 out of 4 consecutive BTSCC exceeded penalty thresholds) was not significantly different at P500; however, it was significantly different for P400, where the odds ratio was estimated to be 1.42 (95% CI: 1.12 to 1.81).

The effect of a global multiculturalism track on cultural competence of preclinical medical students.

BACKGROUND: We evaluated the effect of an elective (the Global Multiculturalism Track), including international and domestic immersion experiences, on the cultural competence of preclinical medical students. METHODS: A self-assessment instrument was used to measure cultural competence, and it was administered to Track participants and nonparticipating class cohorts at the beginning and the end of the preclinical years. RESULTS: Track participants (n=26) had a higher level of cultural competence both at the beginning and at the end of the program. At the end of their second year, students participating in the Track had, for the first time, greater knowledge of certain aspects of local cultures, more tolerance of people of other cultures not speaking English, and more comfort with patients of these cultures, compared with non-Track participants. CONCLUSIONS: The results are based on a small sample size, but the suggestion that a multiculturalism track could provide a model for development of cultural competence warrants further research.

Screening for mental health using adolescent-reported parenting.

BACKGROUND AND OBJECTIVES: Little is known in primary care practices about the relationship between parenting and adolescent mental health. In addition, current parenting measures have a narrow focus or do not lend themselves to clinical intervention. This study examined the clinical utility of a new instrument measuring adolescent-reported parenting, the Parenting Assessment Scale (PAS), to predict adolescent mental health. METHODS: A total of 147 adolescents regularly attending an inner-city clinic were asked to complete the Youth Self Report (YSR), a standard scale measuring mental health, and a PAS for each biological parent. Global scores on the PAS and YSR summarized the reported parenting quality and the adolescents' mental health status. RESULTS: Receiver Operating Characteristics and discrimination analyses showed that the global parenting index was highly predictive of mental health using a z score of .73 (sensitivity = 92.3%, specificity = 88.9%). CONCLUSIONS: The PAS may be useful as a screening tool in older, black adolescent females, although further research is needed to clarify its role in the clinical setting.

Culture of bulk tank milk as a mastitis screening test: A brief review.

The culture of a sample of bulk tank milk may be a useful technique by which to screen herds for major mastitis pathogens. Staphylococcus aureus and Streptococcus agalactiae, if identified on a culture of a sample of bulk milk, reliably indicate infection of the udder. Environmental bacteria, such as the other streptococci and coliforms, are unlikely to be indicative of the proportion of cows infected with these organisms.Samples of bulk milk are readily obtainable and can be rapidly and inexpensively cultured to screen large numbers of herds for mastitis-causing bacteria, yet the performance of the test has only recently been formally assessed for its ability to correctly classify herds according to infection status.A single culture of bulk tank milk has been found to be a test with low sensitivity and high specificity for determining the presence of S. agalactiae or S. aureus in the herd. This means that many infected herds will be called negative, but few uninfected herds will be classified as positive.The literature assessing the performance of bulk tank milk culture in comparison with other mastitis screening tests, the use of bulk milk culture for prevalence surveys, and factors affecting these results is discussed.

A successful research assistantship program as reflected by publications and presentations.

BACKGROUND: Many family practice programs operate student research assistantship programs, but little information is available about the outcomes of these programs. Our summer assistantship program has trained 60 students, all of whom received training in the basic steps of the research process and were required to develop and execute a research project. METHODS: To objectively measure the outcomes of our program, we recorded the number of publications and national presentations achieved by students enrolled in our family practice summer research assistantship program. RESULTS: Nine students have published articles in refereed scientific journals. Nine students have presented research findings at national meetings. Three students have won prestigious student research awards. CONCLUSIONS: Our results suggest students in a research assistantship program can learn basic research skills and execute effective research projects.

Evaluation of two AIDS prevention interventions for inner-city adolescent and young adult women.

Two hundred and fourteen young women received acquired immunodeficiency syndrome (AIDS) prevention interventions at an inner-city family health center serving minority patients predominantly. The community in which the health center is located has a high incidence of intravenous (IV) drug abuse. Either a peer or a health care provider delivered the intervention. In the peer-delivered intervention, a trained peer educator reviewed with patients an AIDS "Rap" videotape and several AIDS brochures, which imparted information about human immunodeficiency virus (HIV), its transmission, and prevention. In the provider-delivered intervention, family practice residents, attending physicians, and nurse practitioners used a patient-centered counseling approach to convey the same information. Questionnaires administered immediately before and after the intervention and at one month follow-up evaluated changes in knowledge, attitudes, and behavior. Analyses of data from both combined intervention groups revealed significant improvements in several areas of knowledge, including the effectiveness of using a condom and cleaning IV drug implements with bleach to prevent transmission of HIV. Many improvements were retained at the one-month follow-up. In addition, subjects in both groups who were sexually active stated immediately after the intervention that asking a sexual partner about past sexual experience would now be less difficult, and at one-month follow-up they reported a significant decrease in the frequency of vaginal sex. Our findings suggest that counseling by physicians can achieve more changes in knowledge of sexual risks, whereas peer education can achieve greater changes in knowledge about IV drug use. Results show that both approaches to AIDS prevention used in this study can significantly affect knowledge, attitudes, and sexual behavior.

PIP: 214 women of average age 20.3 years were subject to an AIDS prevention intervention at a family health center in a high IV drug use community in Worcester, Massachusetts. 116 of the women learned about HIV, its transmission, and prevention with trained peer educators in a review of an AIDS "Rap" video and several AIDS brochures. The remaining 98 women were exposed to the same information, but in a patient-centered counseling approach with family practice residents, attending physicians, and nurse practitioners. 25 women were African-American, 105 Caucasian, 76 Hispanic, and 8 of other ethnic backgrounds. They answered questionnaires regarding their AIDS-related knowledge, attitudes, and practices immediately before, immediately after, and 1 month after exposure to either the peer educator or provider-based education sessions; only 97 completed the follow-up survey. The authors found knowledge on the effectiveness of using condoms and cleaning IV drug implements with bleach to prevent HIV transmission to have significantly improved following the interventions. Many improvements remained at the 1-month follow-up. Moreover, sexually active subjects in both groups noted immediately after the interventions that they would find it easier to ask sex partners about past sexual experiences. A significant decrease was also reported in the amount of vaginal sex at the 1-month follow-up. The authors conclude that while physician counseling may effect more change in the knowledge of sexual risks, peer education may better effect change in knowledge about IV drug use.

Production and related variables in bovine leukaemia virus-infected cows.

A newly developed milk dot blot test was used to detect anti-bovine leukaemia virus (BLV) antibody in milk samples from 2079 lactating adult cows from among 61 herds. The milk dot blot test was highly repeatable; the concordance rate, compared with the agar gel immunodiffusion test performed on serum, was 83.5%. All herds contained BLV-positive cows; the prevalence rate was 36%. BLV-positive cows tended to come from larger herds and were older and more often later in lactation. Fourteen production and related variables (herd size, age, days open, days in milk, milk somatic cell count, milk, fat, and protein produced in the current lactation, projected production of milk, fat, and protein, and breed class average deviations for milk, fat, and protein) were compared between BLV-positive and BLV-negative cows. Although somatic cell count, milk produced, and projected production of milk and protein were related significantly to BLV status using simple tests of association, once the variables herd size, age and days in milk were controlled, these differences were removed. Further analyses using logistic (outcome: individual cow BLV status) and least-squares regression (outcome: herd proportion of BLV-positive cows) failed to show an association between any of the measured production or related variables and BLV-positivity. We concluded that the effect of BLV on production and related variables in dairy cows was below the sensitivity of our analytical techniques or was non-existent.

A case-comparison analysis of elder abuse and neglect.

This study examines factors which contribute to elderly abuse and neglect by caregivers in a domestic setting. Methodological and conceptual variations and problems in previous studies have led to considerable confusion as to the determinants of this important social problem. A more rigorous research design was used in this study than has been previously employed. Fifty-nine abused elders from a model project site for the study of elderly abuse were compared with forty-nine non-abused clients from a home care program in the same agency. Using a research instrument designed by the authors, data related to the following aspects of the lives of the elders and their caregivers were collected: psychological status, stressful life events, social networks, mutual dependency, and the nature of their relationships. The study indicates that members of abusive families are more likely to have emotional problems which contribute to interpersonal difficulties. Abused elders are not more dependent on caregivers for many of their daily needs. However, the abused elderly and their caregivers have become increasingly interdependent prior to the onset of abuse because of the loss of other family members, increased social isolation, and the increased financial dependency of the perpetrator on the elderly person.

Maple syrup urine disease in five hereford calves in ontario.

Five newborn grade horned or polled Hereford calves in Ontario exhibited the clinical signs characteristic of hereditary neuraxial edema, namely, inability to rise, and hyperesthesia with extensor spasms upon tactile or auditory stimulation. Histologically, there was widespread spongy vacuolation in both white and gray matter in the brains of all five calves, especially in the midbrain, brain stem, and cerebellum. Amino acid analysis of formalin-fixed cerebral tissue of three calves demonstrated an amino acid composition consistent with a diagnosis of branched chain keto acid decarboxylase deficiency. This condition has been recently reported in Hereford calves in Australia; it is characterized by the delayed onset of neurological signs and severe lesions of status spongiosus, and has been considered analogous to maple syrup urine disease of children.

The impact of hospice care on families.

The impact of a hospital-based Hospice service for late-stage cancer patients, on the families of fifty-eight bereaved spouses was studied, retrospectively. Hospice care in general was rated significantly higher when compared to the prior care (p less than .001) received by patients and families. Hospice care contributed to improved family functioning and well-being, with the vast majority of spouses reporting feelings of increased support, improved coping by all family members and increased closeness, when compared to prior care. Consequently, over three-quarters of the families reported being emotionally prepared, and prepared in a practical sense, for the death of their loved one. Families appear to be coping reasonably well during bereavement especially those who reported feeling emotionally prepared for the death. Health problems were reported as a large problem in 15 percent of the respondents, which compares favorably to previously documented research on bereavement and illness. These findings indicate that a Hospice mode of care, with its support of families during terminal and bereavement stages, impacts significantly on families' abilities to cope with the terminal phase and adapt afterwards.

Relationship of physician continuity to type of health problems in primary care.

The objective of this study was to determine if the level of continuity of medical care was related to the type of health problems (chronic or acute) presented by patients at four family health centers during a one-year period. Patients with chronic diagnoses encountered significantly fewer physicians and had a higher mean Continuity Index than patients with acute illness diagnoses, even though these two groups made the same number of health center visits for their respective problems during this period. These findings indicate that the prioritizing of clinical problems (whether planned or fortuitous) with respect to the importance of providing continuous care may already be taking place at these health centers. These activities are appropriate if one accepts the premise that, other things being equal, longer illnesses are treated more effectively if there is a consistent knowledge base about a patient and his/her illness, and that this consistency of knowledge is related to the number of providers encountered by that patient.

Methodological, technical, and ethical issues of a computerized data system.

This report examines some methodological, technical, and ethical issues which need to be addressed in designing and implementing a valid and reliable computerized clinical data base. The report focuses on the data collection system used by four residency based family health centers, affiliated with the University of Massachusetts Medical Center. It is suggested that data reliability and validity can be maximized by: (1) standardizing encounter forms at affiliated health centers to eliminate recording biases and ensure data comparability; (2) using forms with a diagnosis checklist to reduce coding errors and increase the number of diagnoses recorded per encounter; (3) developing uniform diagnostic criteria; (4) identifying sources of error, including discrepancies of clinical data as recorded in medical records, encounter forms, and the computer; and (5) improving provider cooperation in recording data by distributing data summaries which reinforce the data's applicability to service provision. Potential applications of the data for research purposes are restricted by personnel and computer costs, confidentiality considerations, programming related issues, and, most importantly, health center priorities, largely focused on patient care, not research.