Incidence, clinical patterns, and risk factors of postpartum uterine diseases in dairy cows from high-altitude tropical herds.

The cow's uterus sustains bacterial contamination and active inflammation after calving as part of the normal physiological process of uterine involution. Although the definition, incidence, and risk factors for postpartum uterine diseases (PUD) have been documented in annual calving systems with high-producing cows on total mixed ration, the literature contains little information for other production systems. The objective of this study was to quantify the incidence risk and factors associated with metritis, clinical endometritis, and cytological endometritis in high-altitude tropical dairy herds in a pasture-based system. A total of 248 cows from 5 commercial dairy herds in northern Antioquia, Colombia, were enrolled in this prospective observational longitudinal cohort study. Data collection and PUD diagnosis were performed at d 0, 3, 10, 17, 24, 31, 38, 45, and 52 (±1) after parturition. Between 60 and 70 d, cows were systematically enrolled in a synchronization protocol, and herds were visited monthly for pregnancy diagnosis until 180 ±15 d. The multivariable logistic regression model of variables associated with PUD occurrence included (a) parity, season of calving, transition diet, and body condition score at calving; (b) blood calcium, phosphorus, and magnesium concentrations, and milk urea nitrogen, ß-hydroxybutyrate and fat-to-protein ratio; and (c) dystocia, retained placenta, and delayed uterine involution. The incidences of puerperal metritis, clinical metritis (MET), clinical endometritis (CE), and cytological endometritis (CYTO) were 2.8, 25, 29, and 26%, respectively. Retained placenta and dystocia were associated with MET, and MET was associated with CE. Low blood calcium concentration at calving was associated with CYTO. Overall, 51.2% of the cows suffered at least 1 category of PUD during the first 60 d postpartum (DPP). However, cows also suffered from different consecutive clinical events of PUD (MET, CE, and CYTO) during the follow-up period (0 to 180 ±15 DPP). These events could be grouped into 4 types (which were referred to as "clinical patterns") based on interactions between MET, CE, and CYTO.

Effectiveness of intrauterine treatment with cephapirin in dairy cows with purulent vaginal discharge.

The objective of this study was to assess the efficacy of cephapirin intrauterine treatment preceding a timed artificial insemination protocol in lactating dairy cows with purulent vaginal discharges (PVDs). Holstein dairy cows (n = 1247) from 18 herds were enrolled in a controlled randomized clinical trial. At 34 days in milk (DIM; ±7 days), cows had a genital examination (transrectal palpation, vaginoscopy, and uterine bacteriology). They were randomly assigned to either the control group (CONT, no treatment) or the treatment group (CEPH) consisting of 1 intrauterine infusion of 500-mg cephapirin benzathine (RCL) (Metricure, Merck Animal Health, Montreal, Canada) regardless of the uterine health status. All cows were systematically enrolled in a presynch-ovsynch protocol for the first insemination. A second genital examination was made 2 weeks later. Cows that received any systemic or local antibiotics 10 days prior sampling to the end of the synchronization protocol were excluded from the study. Reproductive data of cows were collected for at least 300 DIM, entered in a databank, and validated (health record management software, DSAHR). Pregnancy diagnosis was done by transrectal palpation at the routinely scheduled veterinarian visits. On the basis of the highest sum of sensibility and specificity for pregnancy status at 120 DIM, the optimal cutoff for vaginal discharge score was determined as the presence of cloudy discharge with or without purulent material (PVD+, score 2). With a prevalence of 21.6% at 34 DIM, PVD+ was detrimental to the first-service conception rate (FSCR; PVD+: 26 ± 5%; PVD-: 40 ± 3%; P = 0.02). The negative effect of PVD+ was indicated by a hazard ratio of 0.72 (chi-square = 8.58; P < 0.01; 95% confidence interval = 0.56-0.91). Treatment with cephapirin was associated with a significant improvement of the FSCR in PVD+ cows (PVD+ CEPH: 36 ± 5%, PVD+ CONT: 23 ± 5%; P < 0.05), although it did not produce a considerable clinical cure based on the second examination. Thus, a longer period of time following treatment may be needed to properly assess the efficacy of intrauterine treatment in PVD+ cows. In conclusion, cephapirin intrauterine treatment in PVD+ cows at 34 DIM considerably improves reproductive performance compared with untreated PVD+ cows.

Comparison of a leukocyte esterase test with endometrial cytology for diagnosis of subclinical endometritis in postpartum dairy cows.

The objective was to compare a leukocyte esterase (LE) test with endometrial cytology (EC) for diagnosis of subclinical endometritis in dairy cows. The relationship between subsequent fertility and the uterine (Ut) and cervical (Cx) leukocyte esterase activity was determined by the odds of pregnancy by 90 days in milk (DIM). Holstein cows (N = 218) without clinical endometritis and between 21 and 47 DIM from five commercial dairy herds were sampled for uterine and cervical leukocyte esterase activity and EC by cytobrush. To test the effect of time, cows were grouped into early (21-31 DIM) and late (32-47 DIM) animals. There was a slight agreement between UtLE and CxLE (weighted κ = 0.37). The percentage of neutrophils was correlated with esterase score either from the uterus (UtLE; P = 0.0001) or cervix (CxLE; P = 0.002). The percentage of neutrophils on EC (P < 0.001), the UtLE score (P < 0.0001), and the CxLE (P = 0.0009) diminished as DIM increased. Neither CxLE nor UtLE were statistically associated with pregnancy at 90 DIM. However, between 32 and 47 DIM, the percentage of neutrophils on EC and odds of pregnancy at 90 DIM were associated (P = 0.04). For the same interval, based on receiver/response operating characteristics analysis, the optimal cutoff was >6.7% neutrophils to classify cows with subclinical endometritis. In conclusion, uterine LE activity was correlated with percentage of neutrophils as determined by EC, but not with odds of pregnancy. Subclinical endometritis (>6.70% neutrophils) diagnosed by EC between 32 and 47 DIM was associated with reduced odds of pregnancy.

Aberrant expression of E-cadherin and ß-catenin proteins in placenta of bovine embryos derived from somatic cell nuclear transfer.

Abnormal placental development is common in the bovine somatic cell nuclear transfer (SCNT)-derived fetus. In the present study, we characterised the expression of E-cadherin and ß-catenin, structural proteins of adherens junctions, in SCNT gestations as a model for impaired placentation. Cotyledonary tissues were separated from pregnant uteri of SCNT (n = 6) and control pregnancies (n = 8) obtained by artificial insemination. Samples were analysed by western blot, quantitative RT-PCR (qRT-PCR) and immunohistochemistry. Bovine trophectoderm cell lines derived from SCNT and control embryos were analysed to compare with the in utero condition. Although no differences in E-cadherin or ß-catenin mRNA abundance were observed in fetal tissues between the two groups, proteins encoded by these genes were markedly under-expressed in SCNT trophoblast cells. Immunohistochemistry revealed a different pattern of E-cadherin and total ß-catenin localisation in SCNT placentas compared with controls. No difference was observed in subcellular localisation of dephosphorylated active-ß-catenin protein in SCNT tissues compared with controls. However, qRT-PCR confirmed that the wingless (WNT)/ß-catenin signalling pathway target genes CCND1, CLDN1 and MSX1 were downregulated in SCNT placentas. No differences were detected between two groups of bovine trophectoderm cell lines. Our results suggest that impaired expression of E-cadherin and ß-catenin proteins, along with defective ß-catenin signalling during embryo attachment, specifically during placentation, is a molecular mechanism explaining insufficient placentation in the bovine SCNT-derived fetus.

Endocrine profiles of somatic nuclear transfer-derived pregnancies in dairy cattle.

In cattle, several hormones and proteins are necessary for maintenance of a normal pregnancy that will result in a viable calf. Deviation from the normal cascade or expected profile of reproductive hormones and proteins may be associated with impairment of somatic nuclear transfer-derived pregnancies and the high rate of fetal loss. The objectives of this study were to characterize maternal plasma concentrations of pregnancy-specific protein B (PSPB), progesterone (P4), estrone sulphate (E(1)S), and estradiol (E2) during the last two-thirds of pregnancy (cloned calves), and to determine associations with gestational abnormalities. Cows with cloned fetuses, produced by either commercial (N = 16) or zona-free (N = 4) cloning techniques, were compared with pregnant animals derived from traditional embryo transfer (N = 6) or AI (N = 6), at various stages of gestation (Days 80, 120, 150, 180, 210, and 240; Day 0 = estrus). Fetal well-being was monitored with ultrasonography throughout gestation. At Day 80, progesterone concentration was lower (P < 0.0001) in nuclear transfer (NT) recipients than in control groups. Mean estrone sulphate concentrations did not vary significantly between NT and control groups. At Day 150, pregnancy-specific protein B concentrations were elevated (P < 0.002) in NT cows. Estradiol concentration was higher in NT recipients than control cows throughout the study period.

Ultrasonographic and histological characterization of the placenta of somatic nuclear transfer-derived pregnancies in dairy cattle.

The high incidence of pregnancy loss and prenatal morbidity and mortality in cloned animals may be due to placental insufficiency, thereby compromising fetal survival. Our objective was to characterize morphological changes in fetal membranes of cloned bovine pregnancies. Two groups of cows with cloned fetuses, produced by two cloning techniques, a commercial group (n=16) and a hand-made group (n=4), and control fetuses derived from traditional embryo transfer (n=6) or AI (n=6), were compared at various stages of gestation (Days 80, 120, 150, 180, 210, and 240; Day 0=estrus). Thickness and shape of the amniotic membrane, placentome shape and length, umbilical cord shape and diameter, and fetal fluid echodensities were assessed by ultrasonography, and the placenta was evaluated histologically. Only eight (40%) of cloned pregnancies reached term and seven calves (35%) were alive at birth. Both placentome length and umbilical cord diameter were larger (P<0.05) in clones than in normal fetuses at all stages of gestation. Amniotic membrane abnormalities (Day 120) including focal edema and the presence of a series of nodules were detected in 38% of the clones and were always accompanied by hyper-echodense spikes or irregularities (detected ultrasonographically) around the umbilical cord. Histopathology revealed degenerate inflammatory cells, edematous chorioallantoic membranes, and decreased epithelial thickness. We inferred that these morphological anomalies of placentomes compromised fetal development, and we concluded that ultrasonographic monitoring of pregnancies enabled characterization of changes in the placentae and may be useful to assess fetal well-being.

Strategic questions for consumer-based health communications.

Using the consumer-oriented approach of social and commercial marketers, this article presents a process for crafting messages designed to improve people's health behaviors. The process, termed consumer-based health communications (CHC), transforms scientific recommendations into message strategies that are relevant to the consumer. The core of CHC is consumer research conducted to understand the consumer's reality, and thereby allowing six strategic questions to be answered. The immediate result of the CHC process is a strategy statement--a few pages that lay out who the target consumer is, what action should be taken, what to promise and how to make the promise credible, how and when to reach him or her, and what image to convey. The strategy statement then guides the execution of all communication efforts, be they public relations, mass media, direct marketing, media advocacy, or interpersonal influence. It identifies the most important "levers" for contact with the consumer. Everyone from creative specialists through management and program personnel can use the strategy statement as a touchstone to guide and judge the effectiveness of their efforts. The article provides a step by step illustration of the CHC process using the 5 A Day campaign as an example.

Changing physicians' attitudes, knowledge, and self-efficacy regarding cholesterol screening and management.

The National Cholesterol Education Program (NCEP) has identified a need to convey practical approaches for the management of high blood cholesterol (BC) to physicians. Our study was a joint effort between the Pawtucket Heart Health Program and the Brown University Department of Family Medicine to improve family medicine residents' attitudes, knowledge, self-efficacy, and practices regarding cholesterol screening and management. Thirty-six resident physicians received a BC screening and management training program. This program included training in BC screening using the fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for evaluation and treatment of high BC based on NCEP guidelines. The training program also included evaluation of residents' BC screening activity, incentives, chart audits, and biweekly articles in the departmental newsletter. We administered a survey to residents before and one year after the training program began to assess self-reported knowledge, attitudes, self-efficacy, and practices for BC management. Survey results indicated that the residents significantly improved their reported knowledge and attitudes about BC management. In addition, they significantly increased their reported self-efficacy and practices in dietary counseling and patient education. Residents also indicated that the training program was worthwhile, necessary, and practical and that many would use the materials and protocols in their future practices.

A community education monitoring system: methods from the Stanford Five-City Project, the Minnesota Heart Health Program and the Pawtucket Heart Health Program.

Understanding the process of behavior change interventions is critical to achieving campaign effectiveness and successful program replication. The present article presents a community education monitoring system (CEMS) using data from the Stanford Five-City Project (FCP), the Minnesota Heart Health Program (MHHP) and the Pawtucket Heart Health Program (PHHP). CEMS records the number and type of intervention activities, outcome objectives, targets of change (individual, organizational or environmental), channel(s) of dissemination and proportion of programs funded by the community. These data illustrate (1) the application of theory for each project, (2) data-based program administration, (3) feedback for revising programs and (4) type of reach or 'dose' information obtained from intervention monitoring. Process evaluations such as CEMS provide critical links between field realities and evaluation outcomes. This type of evaluation develops standards for measuring program reach and allows comparisons with other programs. CEMS also illustrates how programs enact theory. Validation studies are critical to the continued successful use of CEMS. The first step, however, is to develop a uniform way of describing complex multichannel behavior change programs. CEMS in a refined form should prove invaluable to health promotion program planners whether in research or service settings.

Using the stages of change model to increase the adoption of physical activity among community participants.

PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Enhancing adherence to referral advice given at blood cholesterol screenings: impact on participant follow-up and physician behavior.

Adherence to referral recommendations given to participants at blood cholesterol screening programs is a critical aspect of these efforts to help detect and control high blood cholesterol in the US adult population. In this study, 386 participants who had received two consecutive blood cholesterol measurements above 240 mg/dl (6.21 mmol/l) were interviewed by telephone 3 months after their second measurement (May 1987 - May 1988). Approximately 40% of respondents had seen a physician by the time of the interview; another 30% reported having scheduled an appointment. There was no significant difference in adherence behavior between participants who received a letter reiterating the referral and those who did not. However, participants who received the letter reported greater physician attention to the evaluation and treatment of their high blood cholesterol, primarily because these participants stated that they visited their physician for their high blood cholesterol. Significantly higher rates of further blood tests, cholesterol education material distribution, cholesterol-lowering medication prescription and patient-physician discussions about cholesterol were the result. These findings suggest that consumers can be effective in stimulating and reinforcing physician practice behaviors related to cholesterol control. However, strategies must be crafted so that consumers are aware of, and appreciate, the necessity of seeking physician care when they become aware of a high blood cholesterol level.

Are people more health conscious? A longitudinal study of one community.

Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies.

Community-based approach to weight loss: the Pawtucket "weigh-in".

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Counseling strategies for blood cholesterol screening programs: recommendations for practice.

Blood cholesterol screening programs offer an important venue for nutrition counseling aimed at lowering blood cholesterol levels. This paper presents a screening, counseling and referral protocol that has been developed by the Pawtucket Heart Health Program (PHHP). A review of general considerations for counseling strategies in the screening context highlights the necessity for brief, focused, behaviorially oriented tactics. The PHHP Summary and Referral protocol includes a review of multiple risk factors for heart disease, a discussion of blood cholesterol levels, recommendations for eating pattern changes based on response to a food frequency questionnaire, and a final summary and referral as needed. The training of lay volunteers and health professionals in delivery of the program is also reviewed.

Health practice correlates in three adult age groups: results from two community surveys.

Independently done surveys of a target population can make an important contribution to knowledge about the determinants of personal health behavior by highlighting variables that consistently emerge as significant predictors. This investigation examined the correlates of four health practice and knowledge indices related to cardiovascular disease (CVD) in two baseline community surveys of the Pawtucket Heart Health Program (N = 2,413; N = 2,808). An additional dimension was the use of three adult age groups (18-29, 30-49, 50-64) in conducting the analyses. Results of both surveys showed that sex was the strongest correlate of the four indices--knowledge of CVD, encouraging health practice changes in others, dietary intake, and exercise. The four indices related to CVD were also associated with years of education, primary language, and whether or not a recent cholesterol measurement had been obtained, although these relationships were not as consistent as the results for sex. Overall, about half of each survey's significant associations were also found in the other survey (survey 1, 30 of 62; survey 2, 30 of 56). Consistency of significant results between surveys was best for the group ages 30-49. In either survey, it was rare for an association between a predictor and behavioral index to appear in each of the three age groups. This study supports the importance of the subjects' sex in research on personal health practices, suggests the potential for independence even among health-related indices pertinent to a single type of illness, and emphasizes the usefulness of utilizing independent samples to identify important correlates of health behavior.

Pawtucket Heart Health Program point-of-purchase nutrition education program in supermarkets.

Point-of-purchase nutrition education in supermarkets is one intervention strategy of the Pawtucket Heart Health Program, a community cardiovascular disease prevention program in Pawtucket, Rhode Island. Using consumer intercept interviews, awareness of shelf labels and their effect on purchase behavior have been continuously evaluated. Between 1984 and 1988, the percent of shoppers who could identify correct labels increased from 11 percent to 24 percent (95% confidence intervals of difference: 7.17). The percent who reported they were encouraged to purchase the identified foods increased from 36 percent to 54 percent (95% CI of difference: 5.41).