An evidence-based review of therapies for canine chronic kidney disease.

Successful treatment and prevention of kidney disease in dogs requires a multi-dimensional approach to identify and eliminate causes or exacerbating factors, provide professional evaluation on a regular basis and implement a comprehensive treatment programme when necessary. Over the years, many therapeutic and preventive interventions have been developed or advocated for chronic kidney disease in dogs, but evidence of efficacy or effectiveness is often lacking or highly variable. Accordingly, the main objective of this systematic review was to identify and critically appraise the evidence supporting various aspects of managing canine chronic kidney disease.

Endoscopic balloon dilation of benign esophageal strictures in dogs and cats.

Endoscopic balloon dilation of benign esophageal strictures was performed in 18 dogs and 10 cats with a median age of 4 years. Stricture formation was associated with a recent anesthetic episode in 18 patients. Regurgitation was the most common clinical sign and was present a median of 4 weeks before dilation. Most animals had a single stricture; median diameter was 5 mm, and median length was 1 cm. Esophagitis and mucosal fibrosis were detected in 9 patients each. Dilation was performed with progressively increasing diameter balloons, from 6 to 20 mm. After dilation, mucosal hemorrhage was mild to moderate in most patients. Esophageal perforation was the only serious complication and occurred in 1 patient. Postdilation therapy consisted of administration of cimetidine, metoclopramide, sucralfate, and prednisone in most animals. The median number of dilation procedures performed in each animal was 2, with a range of 1-5. The median interval between dilations was 13 days. Stricture diameter markedly increased with subsequent dilations. Median duration of follow-up was 131 weeks. A successful outcome occurred in 88% of patients, with most animals able to eat canned, mashed, or dry food without regurgitation. Mucosal fibrosis was associated with a better clinical response score, while increasing age was weakly associated with fewer dilations. The dilation protocol used in this group of animals was safe and efficacious.

Introducing ropivacaine into a department's epidural analgesic practice. Improving acute pain service practice.

The results of introducing a new licensed local anaesthetic drug, ropivacaine, into routine practice were evaluated by measuring the efficacy and adverse effects of patient controlled epidural analgesia (PCEA), using ropivacaine 2 mg/ml (R), or the mixtures in current use: fentanyl 5 (micrograms/ml with bupivacaine 1 mg/ml (BF5) and fentanyl 10 (micrograms/ml) with bupivacaine 1 mg/ml (BF10). All patients were nursed on general wards after surgery. For two months, 102 consecutive patients were studied. Pain scores at rest were significantly better in the fentanyl and bupivacaine groups, (mean rank R: 35.5, BF5: 22.7, BF10: 26.9, P < 0.05). There was a significant correlation between patient controlled boluses and pain at rest and (p < 0.001), and pain on moving (p < 0.001). Nausea and vomiting was worse in the BF10 (p < 0.05). Older patients demanded less analgesia (p < 0.001). Postoperatively BF5 provided better pain relief with trends demonstrating fewer side-effects and complications than BF10 or R. We now use fentanyl 5 (micrograms/ml and bupivacaine 1 mg/ml as our standard epidural infusion mixture.

Factors predictive of bone mineral density in eating-disordered women: a longitudinal study.

OBJECTIVE: Osteoporosis in eating-disordered women is well established, but factors predictive of this condition have proved elusive. The roles of behavioral factors, weight, menstrual status, and the degree of bone mineral density change over the clinical course of the eating disorder were investigated METHOD: A cohort of 56 eating-disordered women was subjected to bone mineral density measurement at Scan 1 and were followed up between 9 and 51 months later for repeat measurement (n = 10) at Scan 2. RESULTS: High levels of reduced bone mineral density were observed. Total duration of amenorrhea, body mass index, frequency of vomiting, and cigarette and alcohol consumption accounted for 40% of the variance in spinal bone mineral density measurement at Scan 1. No significant changes in bone mineral density were observed at Scan 2 despite increases in body mass index. DISCUSSION: The results suggest that increases in weight appear not to be sufficient to increase bone mineral density.

The effects of economic circumstances on British students' mental and physical health.

Three-hundred sixty British university students completed a questionnaire providing information on demographic characteristics, financial circumstances, smoking, and drug and alcohol use. A 14-item inventory of physical symptoms, the short form 36 health survey (SF-36), and the General Health Questionnaire (GHQ-12) were used to assess their physical and psychological well-being. Except for physical functioning, all subscales of the SF-36 and the GHQ indicated levels of health significantly below population norms matched for age and sex. Poorer mental health was related to longer working hours outside the university and difficulty in paying bills. Students who had considered abandoning study for financial reasons had poorer mental health, lower levels of social functioning and vitality, and poorer physical health as indicated by variables on the SF-36. They were also heavier smokers. Students' personal debt was significantly associated with their knowing people involved in prostitution, crime, or drug dealing to help support themselves financially.

Variations in self-reported health by occupational grade in the British Post Office: the Q-health project.

Between 1995 and 1998 a national sample of 58,501 (42,885 males, 15,616 females) Post Office employees (29%) completed and returned a postal questionnaire survey providing information on demographic characteristics, physical and psychological health, health and lifestyles and health screening behaviour. Response rates by occupational grade were as follows: manual (male 69.3%, females 43.6%); clerical (male = 11.8%, female, 42.3%); middle management (males 15.5%, females 10.7%) and senior management (males 3.4%, females 3.3%). A number of differences in health status occurred with occupational grade. Angina, high blood pressure, obesity, smoking, arthritis, disability, GP consultations and abnormal smears were all more prevalent in lower occupational grades. Height, job satisfaction, seat belt use and breast self-examination were also lower in lower status jobs. Some findings were unexpected: GHQ scores indicated better mental health in lower grades, whilst knowledge and frequency of testicular self-examination and attendance for mammograms were higher in lower grades. Self-reports for asthma, diabetes and family history of bowel cancer were also greater in higher grades. These findings are considered in terms of response bias, health selection, the psychosocial work environment, occupational health interventions and the nature, meaning and organization of social position within the Post Office.

Body image dissatisfaction and eating attitudes in visually impaired women.

OBJECTIVE: The high levels of body dissatisfaction and abnormal eating attitudes currently prevalent in Western societies have been attributed by many authors to the promotion of an unrealistically thin ideal for women. We investigated the role of the visual media by examining the relationship between body image dissatisfaction and eating attitudes in visually impaired women. METHOD: Questionnaires were administered to 60 women, 20 congenitally blind, 20 blinded later in life, and 20 sighted. RESULTS: Congenitally blind women had lower body dissatisfaction scores and more positive eating attitudes compared to women blinded later in life and sighted women, the latter having the highest body dissatisfaction scores and the most negative eating attitudes. Scores from sighted women were positively correlated with each other. DISCUSSION: The results suggest the importance of the visual media in promoting unrealistic images of thinness and beauty and are discussed from a sociocultural perspective.