Quantitative versus qualitative approaches: a comparison of two research methods applied to identification of key health issues for working horses in Lesotho.

The relative merits and potential complementarity of participatory methods and classical epidemiological techniques in veterinary-related research is a current topic of discussion. Few reported studies have applied both methodologies within the same research framework to enable direct comparison. The aim of this study was to compare issues identified by a classical epidemiological study of horses and their owners with those identified by owner communities using participatory approaches. In 2009, a cross-sectional survey was undertaken as part of an impact assessment study of farrier and saddler training programmes, and a small-scale nutrition trial, implemented in Lesotho by a UK-based equine charity. In total, 245 horses and their 237 owners participated in the survey which comprised a face-to-face structured questionnaire covering knowledge and practices relating to equine husbandry and primary healthcare, clinical examination and sampling of horses, and examination of tack used on those horses. In early 2010, 56 owners in three survey regions, some of whom participated in the survey, attended a participatory workshop. Each workshop group created a local resource map whilst discussing and identifying key issues associated with horse ownership and what might have an adverse impact on horse health and work. Following map completion, each group began by prioritising the identified issues, and then ranked them using a pairwise/ranking matrix to reflect how important issues were in relation to each other. Overall priority issues were: mouth problems, hunger and nutrition, diseases (including infectious diseases, parasites and colic), husbandry (including wound management), and feet and limb problems. Major health issues identified by cross-sectional study included sharp enamel points on teeth, endo- and ectoparasite infestation, suboptimal nutrition, tack-associated wounds, overgrown and poorly balanced feet and poor owner husbandry knowledge and practices. Whilst common issues were identified through the two research approaches, key differences also emerged. The classical, more quantitative approach provided objective measurement of problem frequency, which was compared with owners' perceptions of importance. The qualitative participatory approach provided greater opportunity for researchers to gain detailed understanding of local issues and appreciate how owners defined and prioritised problems affecting them and their animals. Both approaches provided valuable and complementary information that can be used to inform interventions aimed at providing sustainable improvements in the health and wellbeing of working animals and their owners. It is recommended that both quantitative and qualitative approaches are employed as part of detailed needs assessment work prior to defining and prioritising the charity's future interventions.

Cross-sectional survey of owner knowledge and husbandry practices, tack and health issues affecting working horses in Lesotho.

REASONS FOR PERFORMING STUDY: To establish baseline parameters of equine health, owner knowledge and husbandry practices and tack against which benefits to local horses arising from an equine charity's training programme in Lesotho could be measured. OBJECTIVES: To describe and investigate associations between owner knowledge and equine husbandry practices, horse health and tack-related parameters prior to the start of the training programme. METHODS: A cross-sectional survey was undertaken in the catchment area of students attending the first training course. Owners from randomly selected villages were interviewed about horse care using a standardised, structured questionnaire, administered face to face in local language. Horses were clinically examined and tack assessed according to standardised protocols. RESULTS: Clinical examinations were performed on 312 horses and 287 owners were interviewed. Owners had variable knowledge of equine husbandry and limited understanding of appropriate primary and preventive healthcare. Equine health problems identified included ecto- and endoparasite infestation, mouth lesions, overgrown and unbalanced feet and tack-associated wounds. The majority of tack was in poor condition, dirty and ill-fitting. With the exception of below-average body condition score, no associations were found between key adverse horse-related clinical findings and owners reporting their horse as being 'unhealthy'. CONCLUSIONS: Working horses in Lesotho have a range of physical problems, many of which could be ameliorated through targeted owner education. With limited access to veterinary advice and scarce resources, improved availability of affordable local equine trade skills is key to improving equine health. POTENTIAL RELEVANCE: Findings could be used to inform and direct training programmes to maximise benefits to equine health and to serve as a baseline against which to monitor effects of educational and other interventions.

Treatment of extrahepatic congenital portosystemic shunts in dogs - what is the evidence base?

A variety of surgical treatments and medical therapies are recommended for dogs with extrahepatic congenital portosystemic shunts (CPSS). The objective of this review was to assess the evidence base for the management of extrahepatic CPSS in dogs. An online bibliographic search was performed in November 2010 to identify articles relating to the question "Which of the treatment options for extrahepatic CPSS in dogs offers the best short- and long-term outcomes?" Articles were assigned a level of evidence based on a modified grading system. Thirty-eight articles were included in the review. Thirty-six articles were classified as grade 4 and two as grade 5. The timings and methods of assessment of short- and long-term outcomes varied widely between studies. One prospective study (grade 4a) showed that surgically treated dogs survived significantly longer than medically treated dogs. Four retrospective studies (grade 4b) compared the outcome of two surgical techniques but there were no statistically significant differences between treatment groups in terms of complications or outcome. The review found that the evidence base for the treatment of extrahepatic CPSS is weak. There is a lack of evidence of short- and long-term outcomes to recommend one treatment over another.

Assessment of veterinary practitioners in the British Isles' approaches towards the management of canine osteoarthritis.

The aim of this questionnaire-based retrospective study was to ascertain veterinary practitioners in the British Isles' approaches to osteoarthritis in dogs. The Mann-Whitney U test, Kruskal-Wallis test and multiple ordinal logistic regression were used to compare demographic data with treatment options. Questionnaires were returned by 228 practitioners (a response rate of 22.8 per cent). The majority of responses were from males (70 per cent). Eighty-six per cent (188 of 220) of the respondents had graduated from veterinary schools in the UK and Ireland. Veterinarians who had graduated less recently used exercise modulation less frequently (P<0.004, odds ratio [OR]=1.06) and ranked exercise modulation as less important (P=0.008, OR=1.04). Veterinarians who had graduated outside the UK or Ireland were less likely (P=0.033, OR=0.46) to use exercise modulation than those who had graduated in the UK or Ireland. Veterinarians who had graduated more recently were less likely (P=0.008, OR=0.95) to use medications. Female veterinary surgeons were less likely to rank medications as important (P<0.0001, OR=0.29) and less likely to rank corticosteroids as important (P=0.046, OR=0.42) than male veterinary surgeons. Practitioners who had graduated outside the UK or Ireland were less likely (P=0.01, OR=0.30) to rank corticosteroids as important. There was a significant mild negative correlation between the frequency of use of structure-modifying osteoarthritis drugs (SMOADs) and practitioners' opinions on rank importance (-0.32, P<0.0001). Medications such as SMOADs and nutraceuticals were ranked as not important but were used frequently. Overall, age, sex, the university of graduation and the number of canine consultations per day had an impact on the practitioners' treatment protocols.

Does choice of imaging modality affect outcome in dogs with thoracolumbar spinal conditions?

OBJECTIVES: A retrospective cross-sectional study was done to look for differences in outcome in canine spinal patients that had myelography compared to those that had magnetic resonance imaging. METHODS: Medical records of dogs with spinal conditions in the period January 2004 to December 2007 were reviewed. Data on patient age, gender, breed, size, neurolocalisation, rate of onset, imaging modality, time taken to image, type of treatment, neurological grade at admission and discharge, length and cost of hospitalisation and status at discharge were collected. Only dogs with neurological grade 3 to 6 with signs referable to the thoracolumbar spine were included. RESULTS: Of 107 dogs that met the inclusion criteria, 66 (62%) had myelography and 41 (38%) had magnetic resonance imaging. Using multivariable analyses, non-chondrodystrophoid breed, increasing age and higher neurological grade at admission were found to be associated negatively with survival. Neurological grade 5 at admission was found to be associated positively with likelihood of neurological improvement. Male gender, higher neurological grade at admission and medical treatment were associated negatively with length of hospitalisation. magnetic resonance imaging, surgical treatment and period of hospitalisation were associated positively with total cost of hospitalisation. CLINICAL SIGNIFICANCE: No significant association was found between type of imaging and any patient outcome variables except cost of hospitalisation, which was higher for dogs having magnetic resonance imaging. Although magnetic resonance imaging may be considered advantageous compared to myelography because it is non-invasive and provides superior anatomical detail for surgical guidance, no beneficial effect on outcome of dogs with non-ambulatory thoracolumbar spinal disease was found.

Associations between blood gastrin, ghrelin, leptin, pepsinogen and Ostertagia ostertagi antibody concentrations and voluntary feed intake in calves exposed to a trickle infection with O. ostertagi.

Twenty-five, castrated male Holstein-cross calves, between 4 and 5 months of age, weighing 156.5+/-12.2 kg and reared under conditions designed to minimise the risk of parasitic infection, were allocated to one of the five treatment groups on the basis of initial bodyweight. The groups were (1) ad libitum (ad lib) fed controls (ALC); (2) ad lib fed infected (INF) and treated with topical eprinomectin on Day 56; (3) controls pair-fed with the INF group (PFC); (4) ad lib fed controls treated with eprinomectin on Days 0 and 56 (E-ALC) and (5) ad lib fed, infected and treated with eprinomectin on Days 0 and 56 (E-INF). Infection comprised a trickle infection with the equivalent of 10,000 larvae of Ostertagia ostertagi per day from Day 0 to Day 56 and the study concluded on Day 77. Parameters measured throughout the study included: liveweight, feed intake, faecal egg counts; plasma pepsinogen, gastrin, ghrelin and leptin; plasma antibodies to adult O. ostertagi. No significant differences in feed intake or liveweight gain were observed between any of the different groups, a finding thought to result from the high quality of feed offered. Significant differences between the INF and control groups however were observed in faecal egg counts, plasma pepsinogen, gastrin and O. ostertagi antibodies, which were all elevated, and leptin, which was reduced. Values of these parameters for the E-INF group were intermediate between the INF and ALC groups. Plasma ghrelin showed no association with either feed intake or parasitism. Further studies are needed to fully elucidate the roles of various biochemical and neuroendocrine mediators for inappetence in ruminants with parasitic gastroenteritis.

Incidence and risk factors associated with exertional rhabdomyolysis syndrome in National Hunt racehorses in Great Britain.

A telephone survey of 51 National Hunt racing yards with 1140 horses in training was made in April and May 2003 to establish the incidence of exertional rhabdomyolysis syndrome during the previous year. A case-control study was used to investigate the risk factors for the syndrome in eight yards selected on the basis that cases had been confirmed by the analysis of serum muscle enzymes. The overall incidence of syndrome was 6.1 cases per 100 horses per year, and 55 per cent of the yards reported at least one case. The risk factors identified were sex, the average length of the training gallop, and the type of horse (steeplechaser, bumper/unraced or hurdler). There were no significant associations with the horses' temperament, age or Timeform rating.

Can medication packaging improve glycemic control and blood pressure in type 2 diabetes? Results from a randomized controlled trial.

OBJECTIVE: To assess the impact of calendar blister pack (CBP) use on glycemic and blood pressure control. RESEARCH DESIGN AND METHODS: We conducted an 8-month randomized controlled double-blind study among diabetic patients with poor glucose control (HbA1c >9.0%) in an urban area of South Auckland, New Zealand, with a high proportion of Maori and Pacific Islands people. Subjects included 68 consecutive patients, of whom 50% were prescribed three or more medications per day RESULTS: HbA1c was reduced by 0.95+/-0.22% in the CBP group and 0.15+/-0.25% in the control group (P = 0.026). Diastolic blood pressure decreased 5.8+/-1.5 mm Hg in the CBP group and increased 0.1+/-1.9 mm Hg in the control group (P = 0.0041). Systolic blood pressure did not change significantly CONCLUSIONS: CBPs should be considered among diabetic patients with poor glycemic control receiving multiple medications.

What happens to women with preeclampsia? Microalbuminuria and hypertension following preeclampsia.

There is little published data on the incidence of remote hypertension, microalbuminuria (a possible marker of remote cardiovascular events) and diabetes following preeclampsia. This is of particular importance in Pacific Island populations as they have a high rate of preeclampsia, non-insulin dependent diabetes and cardiovascular related deaths. The aim of this study was to compare the rate of microalbuminuria and hypertension in 50 Samoan women with past preeclampsia (cases) with 50 Samoan women who did not have past preeclampsia (controls). Forty per cent of cases were hypertensive at follow-up compared to 2% in the control group (p < 0.0001). Microalbuminuria or proteinuria occurred in 40% of women with past preeclampsia and 18% of controls (p < 0.02). Half of the cases with microalbuminuria were hypertensive. No case or control had an elevated fructosamine, suggesting that current diabetes was an unlikely explanation for the microalbuminuria. We conclude that Samoan women with past preeclampsia are at increased risk of developing chronic hypertension and microalbuminuria. The significance of the microalbuminuria after preeclampsia is not known, but it may be a marker of either remote cardiovascular morbidity or non-insulin dependent diabetes. This study raises longterm health implications for women with preeclampsia.