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Background Nutritional screening and assessment is not currently part of routine clinical practice in Vietnam. Therefore, the present study aimed to investigate the utility of the commonly used methods for identifying malnutrition in outpatients with chronic obstructive pulmonary disease ( COPD). Methods A cross-sectional pilot study and a larger retrospective study were carried out in outpatients with COPD who were attending a respiratory clinic in Ho Chi Minh City, Vietnam. Routine clinical data were collected [body mass index (BMI), forced expiratory volume in 1 s ( FEV1)]. Nutritional screening and assessment were performed using the Malnutrition Screening Tool ( MST) and Subjective Global Assessment ( SGA) as the gold standard to diagnose malnutrition. Results In total, 393 outpatients had documented BMI and 29 were prospectively assessed using SGA: males, n = 25; females, n = 4; mean (SD) age 69.7 (9.6) years; mean (SD) BMI 21.0 (3.4) kg m-2; mean (SD) FEV1 percentage predicted 57.0% (19.7%). Malnutrition risk was identified in 20.7% ( n = 6) of patients using the MST (38% sensitivity; 94% specificity). However, 45% ( n = 13) were diagnosed as malnourished using the SGA (31% mild/moderate; 14% severe). All malnourished patients not identified by the MST had evidence of muscle wasting. BMI had a strong negative correlation with muscle wasting as assessed using the SGA ( r = −0.857, n = 28; P < 0.001) and all malnourished patients had a BMI <21 kg m-2 (range 14.6-20.8 kg m-2, nourished range 20.0-27.6 kg m-2). Conclusions Malnutrition is common in Vietnamese outpatients with COPD. A BMI threshold of <21 kg m-2 appears to represent a useful and pragmatic cut-off point for identifying outpatients requiring comprehensive nutritional assessment and support. [ABSTRACT FROM AUTHOR]

Owners' perceptions and priorities regarding quality of life (QoL) are important considerations given the unknown efficacy of many commonly administered medications, stress of hospital visits, difficulties providing home care, and personal choices including euthanasia. To describe the relative importance of quality versus quantity of life to owners of cats with heart disease. Two hundred and thirty-nine cats with heart disease. Prospective questionnaire-based clinical study. Cat owners completed a questionnaire to identify important parameters when assessing their cat's QoL, the relative importance of quality versus quantity of life, and willingness to trade survival time for QoL. Variables associated with these parameters were evaluated with multivariate analyses. Appetite, owner interaction, sleep patterns, and litterbox habits were deemed important to QoL. Concern over pet suffering was significantly greater than concern over life expectancy. Ninety-three percent of owners were willing to trade survival time for good QoL; 57% of these were willing to trade up to 6 months. On multivariate analysis, the only factor significantly ( P= .002) associated with willingness to trade 6 months was study site. Owner concern regarding stress of administering medications at home increased with number and frequency of medications. These results indicated that QoL is more important to owners of cats with heart disease than longevity. The various priorities and concerns of cat owners should be taken into account in order to provide optimal care. [ABSTRACT FROM AUTHOR]

Background: Congential extrahepatic portosystemic shunts (EHPSS) are common in dogs. An effective minimally invasive technique for correction of EHPSS could result in reduced morbidity, reduced costs, and reduced hospitalization times. Hypothesis: Use of an intravascular occlusion device can effectively and safely result in acute complete occlusion of EHPSS in dogs. Animals: Seven dogs with naturally occurring EHPSS that presented to the Purdue University Veterinary Teaching Hospital. Methods: Prospective, clinical trial. The 7 dogs were consecutively enrolled over a 2-year period. Results of serum biochemistry, total serum bile acids, fasting plasma ammonia, abdominal radiography, and ultrasonography suggested the diagnosis of portosystemic shunts in all dogs. Definitive diagnosis of EHPSS was achieved with cranial mesenteric arterial portography and acute occlusion was attempted by the deployment of the Amplatzer vascular plug (AVP). Results: EHPSS were identified in all dogs consisting of 5 portocaval and 2 portoazygous variants; 1/7 dogs (14%) were intolerant to temporary complete occlusion of the EHPSS. Of the remaining 6 dogs, 5 (83%) had complete occlusion of the EHPSS by the AVP. There were no complications and resolution of abnormal clinical signs and laboratory values was achieved in 4/5 (80%) dogs with complete occlusion. Conclusions and Clinical Importance: Intravascular correction of EHPSS by the AVP is a viable option to surgical correction while larger studies will be required to determine the clinical applicability of this procedure in the broader portosystemic shunt population. [ABSTRACT FROM AUTHOR]

Background: Systemic arterial thromboembolic events are a serious complication of cardiac disease in cats. Objectives: To determine if enoxaparin induces an antithrombotic effect in cats at a dosage of 1 mg/kg SC q12h and if this antithrombotic effect is predicted by anti-Xa activity. Animals: Fourteen clinically healthy cats were divided into 3 groups: control (4 cats), treated and assessed at 4 hours (5 cats), and treated and assessed at 12 hours (5 cats). Methods: A venous stasis model was used and the extent of thrombus formation estimated by measuring thrombus weight and accretion of 125I-fibrinogen. Plasma anti-Xa activity was measured in treated cats. Results: There was a significant reduction in thrombus formation in the 4 h group compared with control (median weight, 0.000 versus 0.565 mg/mm, P < .01; median %125I-fibrinogen accretion, 0.0 versus 42.0%, P < .01). There was a reduction in thrombus formation in the 12 h group (median weight, 0.006 mg/mm, P= .09; median %125I-fibrinogen accretion, 3.83%, P= .09) but this reduction was not significant. The median percent thrombus inhibition for treated cats was 100.0% at 4 hours and 91.4% at 12 hours. Plasma anti-Xa activity was not significantly correlated with thrombus formation. Conclusions and Clinical Importance: This pilot study demonstrates that enoxaparin, when administered at a dosage of 1 mg/kg SC q12h, produces an antithrombotic effect in a venous statsis model in clinically healthy cats. Furthermore, this study demonstrates that anti-Xa activity is a poor predictor of enoxaparin's antithrombotic effect. [ABSTRACT FROM AUTHOR]

Aims To assess the effectiveness and acceptability of peer advisers in diabetes in delivering a programme of training on self-management for people with diabetes. Methods Adults with diabetes were randomly allocated to an education programme delivered either by trained peer advisers or by specialist health professionals. The primary outcome measure was change in knowledge tested before and at the conclusion of the four courses, each consisting of six sessions. Glycated haemoglobin and Diabetes Care Profile were assessed at baseline and at 6 months. Sessional and end-of-course evaluation responses were analysed, as was the attendance record. Results Eighty-three patients were randomized. Of these, 14 failed to attend and two were excluded. Knowledge scores improved significantly in both groups, but there was no difference between the groups for any of the knowledge domains. No difference was noted in the Diabetes Care Profiles or in glycated haemoglobin. The attendance record was similar in both groups. In the post-sessional evaluations, both groups scored highly, with the health professionals significantly more so. The post-course questionnaire exploring patients’ understanding and confidence in self-management of specific aspects of diabetes care revealed no difference between the groups. Conclusions Trained patients are as effective in imparting knowledge to their peers as specialist health professionals. Both are also acceptable to patients as trainers. However, lay tutors require to be given appropriate training, specific to the education programme they would be expected to deliver. [ABSTRACT FROM AUTHOR]

Aim To demonstrate the pharmacodynamic comparability between oral 40 mg pantoprazole delayed-release granules and tablets. Methods This was a multicentre, randomized, open-label, 2-period, 2-sequence, 9-week crossover study in patients aged 18–65 years with gastro-oesophageal reflux disease and documented erosive oesophagitis. The primary endpoint was a comparison of the inhibition of pentagastrin-stimulated maximum acid output (MAO) at steady state after once daily dosing for 1 week and 23 h after the last dose of pantoprazole granules and tablets. Basal acid output was measured prior to MAO. Standard safety evaluations were performed. The one-sided t-test was used to test the null hypothesis that granules – 1.2 × tablet ≥ 0 against the alternative hypothesis that this difference was <0 for both MAO and basal acid output values. Results Sixty patients completed the study. The mean MAO values were 7.11 ± 4.98 and 7.29 ± 4.77 mmol/h, while the mean basal acid output values were 0.74 ± 0.91 and 0.58 ± 0.63 mmol/h for the granules and tablets, respectively. The two formulations were shown statistically to be pharmacodynamically equivalent in suppressing MAO ( P = 0.006), safe and well tolerated. Conclusion Patients with gastro-oesophageal reflux disease who are unable to swallow the tablet may safely be prescribed the pantoprazole sodium granules. [ABSTRACT FROM AUTHOR]

Background Gastro-oesophageal reflux disease (GERD) patients on proton pump inhibitors before breakfast or dinner have acid recovery at night. Bedtime immediate-release omeprazole (IR-OME) demonstrated better control of nocturnal pH than pantoprazole before dinner. Aim To compare repeated once daily bedtime dosing of IR-OME, lansoprazole and esomeprazole on nocturnal gastric acidity. Methods Open-label, randomized, crossover study enrolling 54 patients with nocturnal GERD symptoms comparing IR-OME, lansoprazole and esomeprazole at steady state for nocturnal acid breakthrough (NAB), percentage of time with gastric pH > 4 and median gastric pH. Results Onset of nocturnal acid control with IR-OME was rapid. During the first half of the night, percentage of time with gastric pH > 4 and median gastric pH were significantly higher after IR-OME compared to esomeprazole or lansoprazole ( P < 0.001, both comparisons). Over the 8-h night-time period, acid control with IR-OME was significantly better than lansoprazole ( P < 0.001), and comparable to esomeprazole. IR-OME reduced NAB compared with esomeprazole and lansoprazole (61% vs. 92% and 92%; P < 0.001, both comparisons). Conclusions Bedtime IR-OME provided more rapid control of night-time gastric pH and decreased NAB compared with esomeprazole and lansoprazole. Nocturnal acid control with IR-OME was superior to lansoprazole and comparable to esomeprazole. Bedtime dosing with IR-OME may be effective for patients with night-time heartburn. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if active joint stiffness measured during maximum voluntary knee extension contractions was affected by knee flexion angle. Eighteen subjects volunteered (11 male, seven female). A stretch was imposed on isometric knee contractions performed at 30°, 50°, 70°, 90°, and 110° of knee flexion. Active joint stiffness was computed from the increase in torque relative to the change in knee flexion angle for the first 50 ms of the stretch (approximately 1.5°) and corrected for effects of gravitational component due to leg mass and passive tension. There was a plateau in knee extension torque between 70° and 90° with lower values at all other angles ( P < 0.05). Peak active joint stiffness occurred at 70° with lower values ( P < 0.05) at all other angles except 50°. Stiffness at 70° (441.1 ± 189.9 Nm rad−1) was 49% higher than at 30° and 45% higher than at 110°. Active joint stiffness was dependent on knee flexion angle. Peak joint stiffness during maximal contractions occurred at, or prior to, the optimal angle for torque production for all subjects. [ABSTRACT FROM AUTHOR]

The Southern Nations, Nationalities, and People's Region of Ethiopia (SNNPR) is home to 11 million people constituting more than 45 language and ethnic groups, most of whom live in extremely poor rural communities. Data for currently married, fecund women aged 15-49 from demographic surveys conducted in the SNNPR in 1990 and 1997 are used to investigate contraceptive knowledge and communication, and the use and future need for family planning services in this population. This study focuses on how these processes are affected by household organization and women's status, and on their implications for population policies and programs. Considerations of the implications of these results for understanding the fertility transition of a highly diverse African population under severe stress are presented. Although household extension and polygamy characterize one-third of the women sampled, they do not affect the women's contraceptive behavior. Women's literacy and autonomy are, by far, the most significant forces in the movement toward lower fertility in the region. [ABSTRACT FROM AUTHOR]

1. The pharmacokinetics and pharmacodynamics of lansoprazole, an antisecretory and antiulcer agent, were evaluated in 12 older (> 60 years) and 12 younger (< 60 years) healthy men. 2. Doses of lansoprazole (15 or 30 mg) or placebo were each given once daily for 7 consecutive days in this randomized, double-blind, three-way crossover study. Plasma concentrations and urinary excretion of lansoprazole and its metabolites, and gastric acid secretion were monitored after dosing on days 1 and 7 of each treatment period. 3. Within each age group, lansoprazole pharmacokinetics were linear. The mean clearance and elimination half-life of lansoprazole were about 40% lower and higher, respectively, in the older subjects (CL0: 12-14 vs 20-24 1 h(-1); t1/2,z: 1.90-2.19 vs 1.26-1.44 h). 4. At each dose level, acid secretion was more inhibited in the older group. However, the AUC associated with a 50% decrease in acid secretion was similar (849 vs 892 ng ml(-1) h) for both age groups. Multiple dosing decreased the maximum possible inhibition more in the older group than in the younger group. 5. Since the decrease in acid output associated with equivalent AUCs on day 1 was similar for the two age groups, the greater difference between day 1 and day 7 secretion in the older group indicates that recovery of secretory activity may decline with increasing age.

In Experiment I, keylight was paired with inaccessible grain delivery (under two conditions of keylight intensity) to determine if autoshaping would occur in the absence of primary reinforcement. In Experiment II, the procedure was repeated with accessible grain, for comparison. In Experiment III, the procedures were repeated with explicitly unpaired presentations of keylight and either inaccessible or accessible grain. The results indicated that key pecking occurred as quickly in the presence of keylight pairings with inaccessible grain as with accessible grain, though (except for one bird) key pecking was not maintained with inaccessible grain. Furthermore, compared to the dim keylight, the bright keylight greatly suppressed key pecking when paired with inaccessible grain, and reduced the rate of key pecking when paired with accessible grain. Little key pecking occurred in groups exposed to explicitly unpaired presentations of keylight (whether bright or dim) and grain (whether accessible or inaccessible). When the birds in Experiment III were retested with explicitly paired presentations of keylight and grain, little key pecking was observed, suggesting suppressive effects of prior explicitly unpaired presentations. It is suggested that the effects of key-brightness manipulation were produced by the association of grain with cues other than the response key, or by distraction produced by partial illumination of the grain hopper.