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Background Cats, being obligate carnivores, have unique dietary requirements for nutrients most commonly found in dietary ingredients of animal origin. As such, feeding a diet devoid of animal-derived ingredients has been postulated as a possible cause of nutrient imbalances and adverse health outcomes. A small proportion of cat owners feed strictly plant-based diets to the cats in their care, yet the health and wellness of cats fed these diets has not been well documented. Results A total of 1325 questionnaires were complete enough for inclusion. The only exclusion criterion was failure to answer all questions. Most cats, 65% (667/1026), represented in the survey were fed a meat-based diet and 18.2% (187/1026) were fed a plant-based diet, with the rest fed either a combination of plant-based with meat-based (69/1026, 6.7%) or indeterminable (103/1026, 10%). Cat age ranged from 4 months to 23 years, with a median of 7 years, and was not associated with diet type. No differences in reported lifespan were detected between diet types. Fewer cats fed plant-based diets reported to have gastrointestinal and hepatic disorders. Cats fed plant-based diets were reported to have more ideal body condition scores than cats fed a meat-based diet. More owners of cats fed plant-based diets reported their cat to be in very good health. Conclusions Cat owner perception of the health and wellness of cats does not appear to be adversely affected by being fed a plant-based diet. Contrary to expectations, owners perceived no body system or disorder to be at particular risk when feeding a plant-based diet to cats. This study collected information from cat owners and is subject to bias, as well as methodological limitations. Further research is warranted to determine if these results are replicable in a prospective investigation.

OBJECTIVE To evaluate the influence of owner presence on behavioral and physiologic indicators of fear in dogs during routine physical examinations. ANIMALS 32 client-owned dogs. PROCEDURES Dogs underwent a standardized, video-recorded examination consisting of 6 phases (examination of the head, lymph node palpation, body palpation, axillary temperature measurement, heart rate assessment, and respiratory rate assessment) with or without their owner present in a randomized, controlled study. Behaviors reported to be indicative of fear, including reduced posture, avoidance, escape, lip licking, body shaking, yawning, and vocalizing, were assessed during each phase, and physiologic measurements were assessed during relevant phases by the investigator. Owner presence and sex and age of dogs were investigated for associations with behavioral signs of fear; behavioral and physiologic measurements were compared between groups (owner present vs owner absent). RESULTS Dogs in the owner-present group had a lower rate of vocalizations, lower mean axillary temperature, and higher rate of yawning than dogs in the owner-absent group. Female dogs in the owner-absent group had a higher heart rate than females and males in the owner-present group and males in the owner-absent group, and the rate of lip licking decreased as age increased in the owner-present group. The presence of reduced body posture and rates of lip licking, avoidance behavior, and escape behavior were associated with examination phase. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that, when practical, owners should be encouraged to remain with their dog during routine veterinary examinations. However, effects of owner presence during procedures require further investigation. (J Am Vet Med Assoc 2020;257:1031–1040)

OBJECTIVE To assess handling techniques commonly used during routine examinations and procedures used for calm, fearful, and aggressive cats by veterinarians and nonveterinarian staff at Canadian and US veterinary practices and to evaluate demographic factors associated with those handling techniques. SAMPLE 310 veterinarians and 944 nonveterinarians who handle cats at Canadian and US veterinary practices. PROCEDURES An online questionnaire was developed to evaluate respondent demographics and use of common cat handling practices and techniques. A snowball sampling method was used to send a link to the questionnaire to members of Canadian and US veterinary-affiliated groups. Descriptive statistics were generated; logistic regression was used to identify demographic factors associated with the use of minimal and full-body restraint with scruffing during routine examination and procedures for fearful and aggressive cats. RESULTS Full-body restraint was used to handle cats of all demeanors, although its frequency of use was greatest for fearful and aggressive cats. Veterinarians and nonveterinarians who graduated from veterinary training programs before 2006 were less likely to use full-body restraint for cats of all demeanors, compared with nonveterinarians who did not graduate or graduated between 2006 and 2015. Other factors associated with decreased use of full-body restraint included working at an American Association of Feline Practitioners-certified practice and working at a Canadian practice. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that full-body restraint is commonly used to handle cats. Further research is necessary to determine whether current handling recommendations are effective in decreasing stress for cats during veterinary visits.

BackgroundThe double burden of malnutrition is the co-occurrence of undernutrition (e.g. underweight, stunting, and micronutrient deficiencies) and over-nutrition (e.g. obesity, type 2 diabetes, and cardiovascular disease) at the population, household, or individual level. The objectives of this study were to determine the extent and determinants of individual-level co-morbid anemia and overweight and co-morbid anemia and diabetes in a population in rural Tamil Nadu, South India.MethodsWe undertook a cross-sectional study of adults (n = 753) in a rural region of Tamil Nadu, South India. A survey assessed socio-demographic factors, physical activity levels, and dietary intake. Clinical measurements included body-mass index, an oral glucose tolerance test, and blood hemoglobin assessments. Multivariable logistic regression analyses were used to determine associations between risk factors and two co-morbid double burden pairings: (1) anemia and overweight, and (2) anemia and diabetes.ResultsPrevalence of co-morbid anemia and overweight was 23.1% among women and 13.1% among men. Prevalence of co-morbid anemia and diabetes was 6.2% among women and 6.3% among men. The following variables were associated with co-morbid anemia and overweight in multivariable models [odds ratio (95% confidence interval)]: female sex [2.3 (1.4, 3.85)], high caste [3.2 (1.34, 7.49)], wealth index [1.1 (1.00, 1.12)], rurality (0.7 [0.56, 0.85]), tobacco consumption [0.6 (0.32, 0.96)], livestock ownership [0.5 (0.29, 0.89)], and energy-adjusted meat intake [1.8 (0.61, 0.94)]. The following variables were associated with co-morbid anemia and diabetes in multivariable models: age [1.1 (1.05, 1.11)], rurality [0.8 (0.57, 0.98)], and family history of diabetes [4.9 (1.86, 12.70).ConclusionThis study determined the prevalence and factors associated with individual-level double burden of malnutrition. Women in rural regions of India may be particularly vulnerable to individual-level double burden of malnutrition and should be a target population for any nutrition interventions to address simultaneous over- and undernutrition.

Jurisdictions around the world have implemented indoor tanning legislations, which aim to protect all individuals, especially youth, from dangers of artificial ultraviolet radiation exposure. The objective of this study was to conduct a systematic review to synthesize the available peer-reviewed literature to determine whether indoor tanning legislation has impacted the prevalence of youth indoor tanning. Following PRISMA guidelines, six databases were searched in 2016. Reference lists from relevant articles were also searched. An updated literature search was conducted in 2018. Each article was critically appraised using a merged checklist created from two previously validated checklists. All articles meeting the inclusion criteria were retained after appraisal. Seven studies, all conducted in the U.S., met the inclusion criteria. All studies used an observational, cross-sectional design. There were small absolute decreases in youth indoor tanning prevalence after legislation vs before (n = 3, mean = 3% decrease, range = 1%–6% decrease). Prevalence of youth indoor tanning was significantly lower in states with indoor tanning legislation vs states without legislation (n = 4, mean = 5% lower, range = 1%–18% lower). Prevalence of youth indoor tanning was lower in states with longer standing indoor tanning legislation vs states with more recently implemented legislation (n = 2, mean = 9% lower, range = 2%–20% lower). Indoor tanning legislation is generally associated with lower indoor tanning prevalence among youth. The small percent differences equate to millions of youth at the population level. Longer time lapses from legislation implementation to evaluation, coupled with greater enforcement, compliance, legislative stringency, and public education may result in even more pronounced declines in youth indoor tanning prevalence.

Veterinary visits result in behavioural and physiological signs of fear and stress for many companion dogs. There are a number of factors that likely contribute to this response, but little is known about possible effects of the acoustic environment. The aim of this study was to assess the effect of elevated levels of common veterinary background noises on fear-related responses in dogs during a routine physical examination in a veterinary setting. Testing took place in an examination room at a veterinary clinic and involved 33 owned companion dogs. All dogs received a standardized physical examination where each dog was either presented with no additional noise (n = 16, control), or a pre-recorded noise track that included the sounds of people talking, dogs barking, and metal doors clanging (n = 17). This noise track was played back with a peak sound level of 68.0 dB, which is comparable to levels previously recorded in clinic settings. The dogs’ behavioural responses (lip licking, yawning, reduced posture, avoidance, vocalizing, trembling) were scored from video by a blinded observer for each stage of the physical examination (i.e., head exam, lymph node palpation, body palpation, temperature assessment, heart rate assessment, and respiratory rate assessment). In addition, willingness to approach the examiner was assessed before and after the examination. For behavioural measures, generalized mixed models and Fisher’s exact tests were used to assess the effects of noise, exam phase, sex, and age, with dog as a random effect. For temperature, a general linear model was used to assess the effects of noise, sex, and age, and the remaining physiological measures were assessed using t-tests. Only respiratory rate was increased with exposure to background noise (F1,31 = 6.74, p = 0.0143); no other responses were affected. However, lip licking (F5,65 = 4.04, p = 0.003), avoidance (F5,158 = 6.36, p

Owned, shelter, and laboratory cats undergo handling and restraint throughout their lifetime for routine health examinations and necessary procedures. Many cats display fear and aggressive behaviour during health examinations, and there is potential for these behaviours to result in incomplete examination, and inadequate diagnosis and treatment, which are cat welfare concerns. Given the lack of validated methods to assess cat responses to restraint, the current study aimed to validate two behavioural paradigms: 1) a Handler Aversion Test, and 2) a Conditioned Place Aversion (CPA) test, to assess aversion response differences between passive restraint (the control) and full-body restraint (known to be negative). Cats were initially assessed as either friendly or unfriendly during interactions with a stranger, and this was included as a covariate in analyses. During the Handler Aversion Test, cats were restrained with the passive (n = 20) or full-body (n = 18) restraint, and aversion was assessed by measuring cat latency to approach the handler. CPA testing was carried out separately in laboratory (n = 10) and shelter (n = 42) cats using an apparatus made up of two visually-distinct compartments: cats were handled with passive restraint on one side, and full-body restraint on the other side, with handling methods counter-balanced between compartments. After handling, cats were placed into the apparatus and dwelling time was assessed for each compartment. For the Handler Aversion Test, only 38 out of 51 cats could be trained to walk the required runway, and latency to approach the handler was not significantly different between treatments (P > 0.1). During CPA testing, laboratory cats and friendly shelter cats showed aversion towards the full-body restraint compartment, spending most of their time in the passive compartment (P = 0.043, P = 0.035, respectively); a result not seen in unfriendly shelter cats. The current results suggest that, as assessed in the current study, the CPA test is more sensitive than the Handler Aversion Test for detecting differences in cat aversion responses between a known negative and control restraint technique.

With the widespread use of digital media as a tool for documentation, creation, preservation, and sharing of audio-visual content, new strategies are required to deal with this type of “data” for research and analysis purposes. This article describes and advances the methodological process of using documentary film as a strategy for qualitative inquiry. Insights are drawn from a multimedia study that explored Inuit-caribou relationships in Labrador, Canada, through the co-production of community-based, research-oriented, participatory documentary film work. Specifically, we outline: 1) the influence of documentary film on supporting the project conceptualization and collaboration with diverse groups of people; 2) the strength of conducting filmed interviews for in-depth data collection, while recognizing how place and activities are intimately connected to participant perspectives; and 3) a new and innovative analytical approach that uses video software to examine qualitative data, keep participants connected to their knowledge, and simultaneously work toward creating high impact storytelling outputs. The flexibility and capacity of documentary film to mobilize knowledge and intentionally create research outputs for specific target audiences is also discussed. Continued and future integration of documentary film into qualitative research is recommended for creatively enhancing our abilities to not only produce strong, rich, and dynamic research outputs, but also simultaneously to explore and communicate diverse knowledges, experiences, and stories.

BACKGROUND Blood tests play a vital role in veterinary medicine, as they enable veterinarians to make decisions about their patients' medical care and provide opportunities to engage clients in veterinary care. The objective of this study was to explore perspectives of veterinary clients and veterinarians on current reporting practices for blood tests ordered in companion animal practice. The type of information communicated and client information seeking behaviours were examined. METHODS Two online surveys were distributed using snowball sampling: one targeting veterinary clients and one targeting veterinarians. RESULTS In total, 529 veterinary client and 416 veterinarian surveys were included in analyses. Significant differences were found between what blood test information veterinarian respondents felt they provided clients and what client respondents perceived they received with regard to their pet's blood tests. Almost 60% of clients somewhat or strongly agreed that they search the Internet if they do not understand why a test was ordered or what the results mean. Half of clients reported that they never receive a written report of their pet's blood work, 81% of whom were interested in receiving a copy. CONCLUSION Results of this research demonstrate opportunities to improve veterinarians' and clients' communication about blood tests.

One of the most complex aspects of the veterinarian-client-patient interaction is the clinical decision-making process. Research suggests that the approach to communication used by veterinarians can impact veterinary clients’ involvement in the decision-making process and their ultimate satisfaction. Using different approaches to the decision-making process may affect how information is exchanged and consequently how decisions are made. The objective of this study was to determine pet owners’ expectations with respect to information exchange and decision-making during veterinarian-client-patient interactions and to compare veterinarians’ perceptions of those expectations and the challenges they face in meeting them. Five pet owner focus groups (27 owners) and three veterinarian focus groups (24 veterinarians) were conducted with standardized open-ended questions and follow-up probes. Thematic analysis of the transcribed data was conducted to identify trends and patterns that emerged during the focus groups. Three pet owner-based themes were identified: 1) understanding the client; 2) providing information suitable for the client; and 3) decision-making. In addition, three barriers for veterinarians affecting information exchange and decision-making were identified: 1) time constraints; 2) involvement of multiple clients; and 3) language barriers. Results suggest that pet owners expect to be supported by their veterinarian to make informed decisions by understanding the client’s current knowledge, tailoring information and educating clients about their options. Breakdowns in the information exchange process can impact pet owners’ perceptions of veterinarians’ motivations. Pet owners’ emphasis on partnership suggests that a collaborative approach between veterinarians and clients may improve client satisfaction.

ObjectivesTo assess trends in sexual health outcomes among men who have sex with men (MSM) disaggregated by ethnicity.DesignRepeated cross-sectional.SettingBehavioural surveillance data from 2006, 2008, 2011 and 2014 were collected in-person and online across Aotearoa New Zealand.ParticipantsEligible participants were self-identified men aged 16 years or older who reported sex with another man in the past 5 years. We classified 10 525 participants’ ethnicities: Asian (n=1003, 9.8%), Māori (Indigenous people of Aotearoa New Zealand, n=1058, 10.3%), Pacific (n=424, 4.1%) and European (n=7867, 76.8%).Outcome measuresThe sexual health outcomes examined were >20 recent (past 6 months) male sexual partners, past-year sexually transmitted infection (STI) testing, past-year STI diagnosis, lifetime and past-year HIV testing, lifetime HIV-positive diagnosis and any recent (past 6 months) condomless anal intercourse with casual or regular partners.ResultsWhen disaggregated, Indigenous and ethnic minority groups reported sexual health trends that diverged from the European MSM and each other. For example, Asian MSM increased lifetime HIV testing (adjusted OR, AOR=1.31 per survey cycle, 95% CI 1.17 to 1.47) and recent HIV testing (AOR=1.14, 95% CI 1.02 to 1.28) with no changes among Māori MSM or Pacific MSM. Condomless anal intercourse with casual partners increased among Māori MSM (AOR=1.13, 95% CI 1.01 to 1.28) with no changes for Asian or Pacific MSM. Condomless anal intercourse with regular partners decreased among Pacific MSM (AOR=0.83, 95% CI 0.69 to 0.99) with no changes for Asian or Māori MSM.ConclusionsPopulation-level trends were driven by European MSM, masking important differences for Indigenous and ethnic minority sub-groups. Surveillance data disaggregated by ethnicity highlight inequities in sexual health service access and prevention uptake. Future research should collect, analyse and report disaggregated data by ethnicity to advance health equity.

Nunavut's maternal healthcare system is characterized by rapid transition from community-based birth to a practice of obstetric evacuation and institutionalized birth. Given calls for Inuit self-determination in research, maternal health research - which informs healthcare practices and policies - may need to be conducted differently, using different research methodologies, to include Inuit women's voices and lived experiences. In light of these calls, this article systematically synthesized the published maternal health literature in Nunavut and critically examined reported research methods. This systematic search and critical review involved a comprehensive database search and multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, methodological, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. A hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze research methodology. The initial search yielded 2656 distinct articles and twenty-eight articles met the inclusion criteria. These articles were published from 1975 to 2016, mostly used quantitative research methodology (71.4%), were written from clinical perspectives (57.1%), and focused on maternity care (53.6%). Emergent themes related to both the contributions and areas for growth of research methodology in the conceptualization, initiation, implementation, reporting, and knowledge mobilization stages of the research process. This review revealed opportunities for maternal health researchers to: redress the ongoing impacts of colonization; further include Inuit definitions of health and perspectives on birth in study designs; explore new methodologies that resonate with Inuit ways of knowing; continue (re)aligning research with community priorities; and move from consultation and collaborative partnership in research to Inuit leadership and data ownership. Indeed, this review illustrates that at each step of the research process, opportunity exists for Inuit perspectives and active involvement to shape and define maternal health research in Nunavut.

Background Race and ethnicity classification systems have considerable implications for public health, including the potential to reveal or mask inequities. Given increasing “super-diversity” and multiple racial/ethnic identities in many global settings, especially among younger generations, different ethnicity classification systems can underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic minorities. We investigated three ethnicity classification methods and their relationship to sample size, socio-demographics and sexual health indicators. Methods We examined data from New Zealand’s HIV behavioural surveillance programme for men who have sex with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed; recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included Asian, European, indigenous Māori, and Pacific. For each classification method, statistically significant associations with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic regression. Results Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health outcomes: Māori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using Total Response but not Prioritisation or Single/Combination. Conclusions Different classification approaches alter sample sizes and identification of health inequities. Future research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings have broad implications for surveillance and research that is used to inform public health responses.

Three milestone educational planning initiatives engaged the veterinary medical profession in the United States and Canada between 1987 and 2011, namely the Pew National Veterinary Education Program, the Foresight Project, and the North American Veterinary Medical Education Consortium. In a quantitative study, we investigated the impact of these initiatives on veterinary medical education through a survey of academic leaders (deans, previous deans, and associate deans for academics from veterinary medical schools that are members of the Association of American Veterinary Medical Colleges) to assess their perspectives on the initiatives and eight recommendations that were common to all three initiatives. Two of the recommendations have in effect been implemented: enable students to elect in-depth instruction and experience within a practice theme or discipline area (tracking), and increase the number of graduating veterinarians. For three of the recommendations, awareness of the issues has increased but substantial progress has not been made: promote diversity in the veterinary profession, develop a plan to reduce student debt, and develop a North American strategic plan. Lastly, three recommendations have not been accomplished: emphasize use of information more than fact recall, share educational resources to enable a cost-effective education, and standardize core admissions requirements. The educational planning initiatives did provide collaborative opportunities to discuss and determine what needs to change within veterinary medical education. Future initiatives should explore how to avoid and overcome obstacles to successful implementation.

Background/Objectives. To determine the prevalence and determinants of blood haemoglobin level and mild, moderate, and severe anemia in a sample of adults from rural Tamil Nadu, India.Subjects/Methods. We recruited a sample of men and nonpregnant women aged 20 years and older. Clinical health measures included blood haemoglobin concentration and body mass index. We assessed associations between anemia outcomes and sociodemographic and dietary factors using linear and logistic regression modeling.Results. A total of 753 individuals (412 women and 341 men) participated in this study. The prevalence of anemia was 57.2% among women and 39.3% among men (PPP>0.05). Iron intake was low; 11.7% women and 24.1% of men reported iron intakes above recommended dietary allowances (PConclusion. Both women and men in this region may be particularly vulnerable to anemia, and future research must expand beyond dietary risk factors to examine the impacts of sociodemographic and environmental factors.

Cats routinely undergo handling and restraint for examinations and procedures throughout their lifetime. In recent years there has been increased awareness that some forms of restraint have the potential to negatively impact cat health and welfare, but there has been limited research to assess alternatives. Full-body restraint is known to be aversive and cause stress responses across a range of species. The current study therefore validated measures for identifying negative cat responses to handling by comparing passive restraint (n = 22; the control treatment) to full-body restraint (n = 25; negative treatment), during a physical examination. Given that cats respond differently to unfamiliar people, and handlers are often unfamiliar to cats, an Unfamiliar Person Test was used to account for differences in cat responses to an unknown handler. Cats were then restrained according to treatment, and assessed for behavioural and physiological responses during the following phases: 1) placement into restraint, 2) restraint, and 3) post-restraint. The results show the odds of struggling were 8.2 (95% CI: 1.47, 58.53; P = .009) times greater in cats being placed into full-body restraint in comparison to passively restrained cats. During the physical examination, full-body restrained cats showed more breaths per minute (P = .004), more lip licks per minute (F1,42 = 6.18; P = .017), and were more likely to hold their ears in a back or side position during the first 15 s of handling (P

The first case of porcine epidemic diarrhea (PED) in Canada was diagnosed in January 2014 in Ontario, approximately 9 months after PED emerged in the United States. An early investigation of the Canadian outbreak suspected that the probable source of the virus was contaminated feed. The objective of this study was to evaluate the role of feed and other possible factors in the early phase of the PED outbreak in Canadian swine herds. The study period of interest for this case-control study was January 22nd to March 1st, 2014. A case herd was defined as a swine herd with a confirmed positive laboratory diagnostic test (RT-PCR) results for PED virus, along with pigs exhibiting typical clinical signs at the herd level during the study period. A questionnaire was administered to participating producers from the 22 Canadian swine herds enrolled ( n = 9 case and n = 13 control herds). Case herd producers were asked to provide information from the initial day of onset of clinical signs and 30 days prior to that day. Control herds were matched to a case herd on the basis of province, herd type and approximate size. The period of interest for a control herd was matched to the initial day of clinical signs of PED for the case herd, along with the 30 days prior to this day. The questionnaire questions focused on herd demographics, biosecurity protocols, live animal movements onto and off sites, deadstock movements, feed and people movements for both the case and control herds. The questionnaire for control herds were based on their matched case’s period of interest, and together with case herds formed a matched stratum. Multivariable exact conditional logistic regression and mixed multivariable logistic regression models, with the matched stratum as a random effect, were used to assess the association between various risk factors and the odds of PED introduction into a herd. After adjusting for biosecurity practices, the odds of a PED occurrence was 38.1 (95% CI: 2.7–531.3) times greater for herds receiving feed from a single feed company that provided potentially contaminated feed ( P = 0.007) than herds that did not. The number of live pigs delivered onto sites, semen deliveries and the frequency of deadstock pickups were not associated with PED status during the initial phase of the outbreak in univariable analyses. This study supports the role of potentially contaminated feed from a single feed company as a significant risk factor for PED viral introduction during the early phase of the Canadian outbreak.

Fear and aggression in dogs within veterinary clinics can lead to canine welfare impairments and pose a safety concern for veterinary staff. However, few studies have explored potential underlying causes for this fear and aggression. We used an online cross-sectional survey targeted to current dog owners to examine risk-factors associated with fear and aggression within veterinary clinics. The factors we assessed in the survey were related to dog characteristics (e.g., sex, breed), fear and aggression responses in everyday scenarios (e.g., stranger-directed fear), experiences at the veterinary clinic (e.g., frequency of visits), training, early socialization, and owner demographics (e.g., gender, age). Data were analyzed using mixed linear regression models, with participant as a random effect to account for multiple dogs within the same household. For fear within veterinary clinics, dogs (n = 1346) were significantly more likely to be rated as fearful by their owners if they were neutered at ≤1 year of age; received their first nail trim at an older age; were rated as having severe non-social fear, or stranger-directed fear and aggression, or as being stressed or aggressive during body handling; had a negative change in behaviour after an aversive clinic experience; and if owners indicated being nervous during situations within the veterinary clinic. For aggression within veterinary clinics, dogs (n = 1776) were more likely to be rated as aggressive if they were reported to be fearful of the veterinary clinic, fearful of feet toweling, or stressed or aggressive during body handling, if the owner reported using positive punishment during routine training, or if any of the following had occurred during clinic visits: examination shortened, use of towel restraint or muzzling, dog bite directed at staff member, general use of positive punishment on the dog, and if the owner indicated being nervous during situations within the veterinary clinic. Random effects for participant were significant for both fear and aggression models, with intra-class correlation coefficients of 0.36 (CI: 0.21−0.54, p = 0.0004) and 0.16 (CI: 0.06−0.36, p = 0.017), respectively, indicating some correlation in behaviour amongst dogs owned by the same person. These results suggest that both fear and aggression within veterinary clinics are related to dog personality, previous early experiences and veterinary clinic experiences, and owner experiences during veterinary visits. These findings can be used to generate hypotheses for future research aimed at preventing the development of fear and aggression within a veterinary setting.

Many dogs show signs of fear during veterinary appointments. It is widely recommended to use desensitization and counter-conditioning training to reduce this fear. However, the efficacy of this method for reducing veterinary fear has not been examined. We assessed the effect of a standardized four-week training program on behavioural and physiological signs of fear in dogs with pre-existing veterinary fear. Owned dogs were randomly allocated to receive training (n = 15) or no training (n = 22, Control). Owners of dogs in the training group were instructed to perform exam-style handling on their dog and to visit the veterinary clinic weekly. Owners of control dogs were given no instructions. Fear responses were assessed before and after the training period by a blinded observer during clinic arrival and examination. Despite motivated owners volunteering to participate in the current study, 44% of owners were non-compliant to this training program. During examination, control dogs had higher odds (95% confidence Interval (CI)) of reduced posture compared to trained dogs (Odds ratio (OR): 3.79, CI: 1.03&ndash, 16.3). Fear scores for trained dogs lowered during the second examination (p = 0.046), and 86.7% of dog owners reported a reduction in their dog&rsquo, s fear levels across the training period (p = 0.007). When entering the clinic (p = 0.002) and during examination (p = 0.002), trained female dogs had a higher rate of lip licking than control females. The training program did not influence temperature, heart rate, respiratory rate, avoidance, trembling, vocalizations, or willingness and encouragement to step on the scale. Results suggest that this four-week training program was mildly effective at reducing veterinary fear in dogs. Further research is necessary to explore the efficacy of longer, more intensive, and individualized training programs.

Background Beliefs of pet owners strongly influence their decision-making surrounding their pets’ diet. Thus, nutritional guidance is an essential component of veterinary practice and integral to managing rising rates of pet obesity. This study examined pet owners’ trust of, perceived effectiveness of, and intentions to follow nutritional guidance received from their veterinarian in managing their pets’ diet. Methods A cross-sectional study of 1402 dog and cat owners in the USA and Canada was conducted using an online questionnaire tool. Data were analysed using descriptive statistics and logistic regression modelling. Results Clients are concerned about the effectiveness of veterinary nutrition recommendations. Cat owners were more likely than dog owners to consider the nutritional guidance they receive from veterinarians effective for their pets’ diet (1.75, P=0.04). Length of pet ownership, feeding dry diets and frequency of veterinary visits were all positively associated with owners considering veterinary nutritional guidance to be effective in managing pets’ diet. Conclusion Identifying these perspectives can aid in developing strategies to provide nutrition support to pet owners to improve their perceptions of, self-efficacy with, and compliance with veterinary nutrition recommendations.

Porcine epidemic diarrhea virus (PEDV) emerged into Canada in January of 2014. The virus was considered to be of high importance and the number of new cases were tracked using different mechanisms by stakeholders such as veterinary services from the provincial government and the swine industry. In addition to the initial date of infection, veterinary organizations in the swine industry maintained a disease control program (DCP) database that contained the date of declaration of freedom from PEDV in individual herds. Such data allowed for the determination of the duration of PEDV infection in individual herds based on herd type, year and season of diagnosis. Therefore, the objective of this study was to determine time to PEDV elimination in Ontario swine herds infected between 2014 and 2017, on the basis of records from the DCP database; and to identify factors associated with the likelihood of elimination. Duration of time to eliminate PEDV was estimated using Kaplan-Meier survival curves. The final Cox's proportional hazard model included herd type, season and year of diagnosis. The hazard of PEDV elimination for premises that were farrow-to-wean was 3.36 times larger (P-value: 0.044, 95% CI: 1.03, 10.93) than for farrow-to-feeder herds. Herds diagnosed in the summer and fall had hazard ratios of 1.40 (P-value: 0.044, 95% CI: 1.03, 10.93) and 7.32 (P-value

BackgroundAlthough searching for health information on the internet has offered clear benefits of rapid access to information for seekers such as patients, medical practitioners, and students, detrimental effects on seekers’ experiences have also been documented. Health information overload is one such side effect, where an information seeker receives excessive volumes of potentially useful health-related messages that cannot be processed in a timely manner. This phenomenon has been documented among medical professionals, with consequences that include impacts on patient care. Presently, the use of the internet for health-related information, and particularly animal health information, in veterinary students has received far less research attention.ObjectiveThe purpose of this study was to explore veterinary students’ internet search experiences to understand how students perceived the nature of Web-based information and how these perceptions influence their information management.MethodsFor this qualitative exploratory study, 5 separate focus groups and a single interview were conducted between June and October 2016 with a sample of 21 veterinary students in Ontario, Canada.ResultsThematic analysis of focus group transcripts demonstrated one overarching theme, The Overwhelming Nature of the Internet, depicted by two subthemes: Volume and Type of Web-based Health Information and Processing, Managing, and Evaluating Information.ConclusionsIntegrating electronic health information literacy training into human health sciences students’ training has shown to have positive effects on information management skills. Given a recent Association of American Veterinary Medical Colleges report that considers health literacy as a professional competency, results of this study point to a direction for future research and for institutions to contemplate integrating information literacy skills in veterinary curricula. Specifically, we propose that the information literacy skills should include knowledge about access, retrieval, evaluation, and timely application of Web-based information.

Type 2 diabetes mellitus is an escalating public health problem in India, associated with genetic susceptibility, dietary shift, and rapid lifestyle changes. Historically a disease of the urban elite, quantitative studies have recently confirmed rising prevalence rates among marginalized populations in rural India. To analyze the role of cultural and sociopolitical factors in diabetes onset and management, we employed in-depth interviews and focus groups within a rural community of Tamil Nadu. The objectives of the study were to understand sources and extent of health knowledge, diabetes explanatory models, and the impact of illness on individual, social, and familial roles. Several cultural, socioeconomic, and political factors appear to contribute to diabetes in rural regions of India, highlighting the need to address structural inequities and empower individuals to pursue health and well-being on their own terms.

Interdisciplinary health research that investigates gender as a relational process is necessary to facilitate a safe and healthy resettlement process for refugees in Canada. This scoping review explores the range, nature, and extent of published research examining gender in relation to refugee health during resettlement in Canada. An initial search of six databases yielded 7325 articles published before June 2019. A total of 34 articles published between 1988 and 2019 were included for in-depth review. Articles meeting inclusion criteria primarily focused on refugee women. Categories of focus included maternal health, social and emotional health, health impacts of sexual and gender-based violence and torture, access to health and social services, decision-making and health-seeking behavior, mental health, and sexual and reproductive health. Our thematic analysis identified connections between gender roles, expectations, ideals, and health through interactions and lived experiences within the family, community, and healthcare system. Review findings suggest that many refugee women are influenced by pervasive gender roles and expectations as well as exposed to gendered health systems and practices that may pose risks to health, particularly mental health and access to services. Further efforts should be made to understand processes and experiences of resilience and community building in countering negative impacts of gendered beliefs and practices on health during resettlement.

Use of scruffing and scruffing tools (eg, clipnosis clips) to immobilise cats is contentious, and cat handling guidelines vary in recommendations regarding these techniques. The current study examined whether cats show negative responses to the following restraint methods: (1) scruff (n=17), (2) clip application to the dorsal neck skin (n=16) and (3) full body (a known negative; n=19). Each cat was also handled with passive restraint (control) for comparison. During handling, cats were examined for behavioural (side/back ear positions, vocalisations, lip licking) and physiological (pupil dilation ratio, respiratory rate) responses. Full-body restrained cats showed more negative responses than passively restrained cats (respiratory rate: p=0.006, F3,37=4.31, p=0.01; ear p=0.002, F3,49=6.70, p=0.0007; pupil: p=0.007, F3,95=14.24, p=0.004; vocalisations: p=0.009, F3,49=4.85, p=0.005) and scruff-restrained cats (pupil: p=0.009; vocalisations: p=0.04). Clip restraint resulted in more negative responses than passive (pupil: p=0.01; vocalisations: p=0.007, ear p=0.02) and scruff restraint (pupil p=0.01; vocalisations: p=0.02). No differences were detected between full-body restraint, known to be aversive, and clip restraint. Full-body restraint and clip restraint resulted in the greatest number of negative responses, scruffing resulted in fewer negative responses and passive restraint showed the least number of responses. We therefore recommend against the use of full-body and clip restraint, and suggest that scruff restraint should be avoided when possible.

Objectives The aim of the study was to identify any dietary, signalment, geographic and clinical factors associated with hematuric struvite crystalluria (HSC) in a population of cats that visit general care veterinary hospitals in the USA. Methods In total, 4032 cats that had a first-time diagnosis of HSC and 8064 control cats with no history of hematuria or crystalluria were identified from medical records of all cats examined between 2007 and 2011 at 790 US veterinary hospitals. Extracted variables included age, sex, neuter status, breed, diet, urinalysis results and history of cystitis. Potential associations between these variables and HSC were estimated. Results Controlling for other factors, young cats fed a dry diet had an increased likelihood of HSC relative to young cats fed a non-dry diet. However, as age increased, the likelihood of HSC declined for cats fed a dry diet and increased for cats fed a non-dry diet. Moreover, the odds of HSC were significantly greater when cats were unneutered (vs neutered; odds ratio [OR] 45.52) or had a thin (vs heavy) body condition (OR 23.81), diagnosis of cystitis (OR 2.84), urine protein concentration >30 mg/dl (OR 4.72), alkaline (vs neutral) urine pH (OR 3.34), pyuria (OR 23.67) or bacteriuria (OR 2.24). Conclusions and relevance The present study provides estimates of the strengths of association between HSC and certain signalment and clinical characteristics of cats. This information could help clinicians to perform a more directed screening for struvite crystalluria in certain cat populations. Follow-up studies that build on the findings of this study could explore the clinical importance of HSC in cats.

Background Many jurisdictions have enacted indoor tanning legislation in response to the health risks of artificial ultraviolet (UV) radiation exposure. Key components of these legislations include banning minors’ access, requiring parental consent or accompaniment, providing protective eyewear, posting health warning signs, and communicating important health risk information. However, legislation must be complied with to be impactful. Evidence around compliance with indoor tanning legislations has not been synthesized and is an important step toward determining changes in practice due to legislation. Methods A systematic review was conducted to obtain peer-reviewed literature about compliance with indoor tanning legislation worldwide. Six databases were searched, resulting in 12,398 citations. Sixteen studies met the inclusion criteria (peer-reviewed scientific studies, published in English, focused primarily on compliance with indoor tanning legislations, and focused on commercial indoor tanning in indoor tanning facilities). Results Compliance with most aspects of indoor tanning legislation varied widely. There was good compliance for provision of protective eyewear (84 to 100%; mean = 92%; SD = 8). Compliance with age restrictions ranged from 0 to 100% (mean = 65%; SD = 25), while compliance with posting warning labels in the required locations within a tanning facility ranged from 8 to 72% (mean = 44%; SD = 27). Variation in compliance may be due to true differences, study methodology, or temporal trends. Conclusions Variability in compliance with indoor tanning legislation, as found in this systematic review, indicates the legislations may not be having their intended protective effects on the public’s health. The reasons for such low and varied compliance with certain aspects of legislation, and high compliance with other aspects of legislation, deserve further attention in future research to inform best practices around ensuring high and consistent compliance with indoor tanning legislations worldwide. Electronic supplementary material The online version of this article (10.1186/s12889-018-5994-4) contains supplementary material, which is available to authorized users.

Objectives Our objectives were to investigate demographic and behavioural factors associated with condom use and to examine how habitual condom use was across partner types and sexual positions among younger men who have sex with men (YMSM), aged 16–29, surveyed in New Zealand. Methods We analysed the 2006–2011 national HIV behavioural surveillance data from YMSM who reported anal intercourse in four scenarios of partner type and sexual position: casual insertive, casual receptive, regular insertive and regular receptive. For each, respondents’ condom use was classified as frequent (always/almost always) or otherwise, with associated factors identified with multivariate mixed-effect logistic regression. Habitual condom use across scenarios was examined using a latent variable technique that estimated the intraclass correlation coefficient (ICC). Results Frequent condom use was reported for 63.6% of 5153 scenarios reported from 2412 YMSM. Frequent use increased from boyfriend to fuckbuddy to casual partners. Infrequent use was associated with online recruitment, Pacific ethnicity, less education, HIV positivity, sex with women, having ≥20 sexual partners versus 1 and reporting insertive and receptive sexual positions. Frequent condom use was associated with having two to five sexual partners versus one and shorter regular partnerships. The ICC=0.865 indicated highly habitual patterns of use; habitual infrequent condom use was most prevalent with regular partners (53.3%) and habitual frequent condom use was most prevalent with casual partners (70.2%) and for either sexual position (50.5% and 49.1%). Conclusions Habitual condom use among YMSM highlights the value of early, engaging and sustained condom promotion. Public health should provide better and more compelling condom education, training and promotion for YMSM.

Calcium oxalate urolithiasis results from the formation of aggregates of calcium salts in the urinary tract. Difficulties associated with effectively treating calcium oxalate urolithiasis and the proportional increase in the prevalence of calcium oxalate uroliths relative to other urolith types over the last 2 decades has increased the concern of clinicians about this disease. To determine factors associated with the development of calcium oxalate urolithiasis in dogs evaluated at general care veterinary hospitals in the United States, a retrospective case-control study was performed. A national electronic database of medical records of all dogs evaluated between October 1, 2007 and December 31, 2010 at 787 general care veterinary hospitals in the United States was reviewed. Dogs were selected as cases at the first-time diagnosis of a laboratory-confirmed urolith comprised of at least 70% calcium oxalate (n=452). Two sets of control dogs with no history of urolithiasis diagnosis were randomly selected after the medical records of all remaining dogs were reviewed: urinalysis examination was a requirement in the selection of one set (n=1808) but was not required in the other set (n=1808). Historical information extracted included urolith composition, dog's diet, age, sex, neuter status, breed size category, hospital location, date of diagnosis, and urinalysis results. Multivariable analysis showed that the odds of first-time diagnosis of calcium oxalate urolithiasis were significantly (P0.05) greater for dogs7 years, males (OR: 7.77, 95% CI: 4.93-12.26), neutered (OR: 2.58, 1.44-4.63), toy- vs. medium-sized breeds (OR: 3.15, 1.90-5.22), small- vs. medium-sized breeds (OR: 3.05, 1.83-5.08), large- vs. medium-sized breeds (OR: 0.05, 0.01-0.19), and those with a diagnosis of cystitis within the previous year (OR: 6.49, 4.14-10.16). Urinary factors significantly associated with first-time diagnosis of calcium oxalate urolithiasis were acidic vs. basic pH (OR: 1.94, 1.22-3.10), presence of RBCs (OR: 6.20, 3.91-9.83) or WBCs (OR: 1.62, 1.03-2.54), and protein concentration30 mg/dL (OR: 1.55, 1.04-2.30). Patient demographics and urinalysis results are important factors that can support risk assessment and early identification of canine oxalate urolithiasis. Therefore, periodic urolith screening and monitoring of urine parameters should be encouraged for dogs at risk of developing these uroliths.

Objective To identify incidence and risk factors for surgical glove perforation in small animal surgery. Study Design Observational cohort study. Sample Population Surgical gloves (n = 2132) worn in 363 surgical procedures. Methods All gloves worn by operative personnel were assessed for perforation at end-procedure using a water leak test. Putative risk factors were recorded by a surgical team member. Associations between risk factors and perforation were assessed using multivariable multi-level random-effects logistic regression models to control for hierarchical data structure. Results At least 1 glove perforation occurred in 26.2% of procedures. Identified risk factors for glove perforation included increased surgical duration (surgery >1 hour OR = 1.79, 95% CI = 1.12–2.86), performing orthopedic procedures (OR = 1.88; 95% CI = 1.23–2.88), any procedure using powered instruments (OR = 1.93; 95% CI = 1.21–3.09) or surgical wire (OR = 3.02; 95% CI = 1.50–6.05), use of polyisoprene as a glove material (OR = 1.59, 95% CI = 1.05–2.39), and operative role as primary surgeon (OR = 2.01; 95% CI = 1.35–2.98). The ability of the wearer to detect perforations intraoperatively was poor, with a sensitivity of 30.8%. Conclusions There is a high incidence of unrecognized glove perforations in small animal surgery.

Objective—To identify factors associated with development of struvite urolithiasis in dogs evaluated at general care veterinary hospitals in the United States. Design—Retrospective case-control study. Animals—508 dogs with a first-time diagnosis of struvite urolithiasis and 7,135 control dogs. Procedures—Electronic medical records of all dogs evaluated at 787 general care veterinary hospitals in the United States between October 2007 and December 2010 were reviewed to identify dogs that developed struvite urolithiasis and 2 groups of control dogs with no history of urolithiasis. Information extracted included diet, age, sex, neuter status, breed size category, hospital location, and date of diagnosis. Urinalysis results, urolith composition, and other disease conditions were recorded if applicable. Potential risk factors were assessed with univariable and multivariable regression analysis. Results—Toy- or small-sized breeds had significantly greater odds of struvite urolithiasis, compared with medium- or large-sized breeds. Neutering significantly increased the odds of this outcome in females only; sexually intact females were more likely to develop struvite urolithiasis than were sexually intact males, but only up to 5 years of age. Urinary factors significantly associated with the outcome were basic (vs acidic) pH, presence of RBCs or WBCs, protein concentration > 30 mg/dL, and ketone concentration ≥ 5 mg/dL. Conclusions and Clinical Relevance—Evaluation of demographic characteristics and urinalysis results may be useful in the early identification of struvite urolithiasis in dogs. Periodic urinalysis in dogs is recommended because of the potential health impact of a late diagnosis of urolithiasis.

Background Internal labour migration is an important and necessary livelihood strategy for millions of individuals and households in India. However, the precarious position of migrant workers within Indian society may have consequences for the health of these individuals. Previous research on the connections between health and labour mobility within India have primarily focused on the negative health outcomes associated with this practice. Thus, there is a need to better identify the determinants of internal migrant health and how these determinants shape migrant health outcomes. Methods An exploratory mixed methods study was conducted in 26 villages in the Krishnagiri district of Tamil Nadu. Sixty-six semi-structured interviews were completed using snowball sampling, followed by 300 household surveys using multi-stage random sampling. For qualitative data, an analysis of themes and content was completed. For quantitative data, information on current participation in internal labour migration, in addition to self-reported morbidity and determinants of internal migrant health, was collected. Morbidity categories were compared between migrant and non-migrant adults (age 14–65 years) using a Fisher’s exact test. Results Of the 300 households surveyed, 137 households (45.7%) had at least one current migrant member, with 205 migrant and 1012 non-migrant adults (age 14–65 years) included in this study. The health profile of migrant and non-migrants was similar in this setting, with 53 migrants (25.9%) currently suffering from a health problem compared to 273 non-migrants (27.0%). Migrant households identified both occupational and livelihood factors that contributed to changes in the health of their migrant members. These determinants of internal migrant health were corroborated and further expanded on through the semi-structured interviews. Conclusions Internal labour migration in and of itself is not a determinant of health, as participation in labour mobility can contribute to an improvement in health, a decline in health, or no change in health among migrant workers. Targeted public health interventions should focus on addressing the determinants of internal migrant health to enhance the contributions these individuals can make to their households and villages of origin.

Background India’s national rural prevalence of type 2 diabetes has quadrupled in the past 25 years. Despite the growing rural burden, few studies have examined putative risk factors and their relationship with glucose intolerance and diabetes in rural areas. We undertook a cross-sectional study to determine the prevalence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes in a rural area of south India. In addition, we determined which factors were associated with type 2 diabetes. Methods We sampled 2 % of the adult population from 17 villages using a randomized household-level sampling technique. Each participant undertook a questionnaire that included basic descriptive information and an assessment of socioeconomic status, physical activity, and dietary intake. Height, weight, waist and hip circumference, and blood pressure measurements were taken. An oral glucose tolerance test was used to determine diabetes status. We used stepwise logistic model building techniques to determine associations between several putative factors and type 2 diabetes. Results 753 participants were included in the study. The age- and sex-standardized prevalence of IFG was 3.9 %, IGT was 5.6 %, and type 2 diabetes was 10.8 %. Factors associated with type 2 diabetes after adjusting for confounders included physical activity [OR 0.81], rurality [OR 0.76], polyunsaturated fat intake [OR 0.94], body mass index [OR 1.85], waist to hip ratio [OR 1.62], and tobacco consumption [OR 2.82]. Conclusion Our study contributes to the growing body of research suggesting that diabetes is a significant concern in rural south India. Associated risk factors should be considered as potential targets for reducing health burdens in India.

Porcine high fever disease (PHFD) emerged in 2006 in China and spread to Vietnam. Little work has been carried out to investigate PHFD risk factors and space-time dynamics. To fill this gap, we investigated probable cases of PHFD at household level as the outcome. A study area, approximately 100 sq. km, was selected from a province of southern Vietnam that had reported the outbreak of PHFD in 2008. A survey was conducted in the study area to collect information about swine health problems during 2008. The questionnaire included three sections: general information, clinical signs of disease in pigs and production factors believed to be risk factors. Cases were defined at the household level and included interpretation of clinical signs in series. Logistic regression with a random intercept at the hamlet level was used to assess risk factors for PHFD at the household level. Spatial clustering was investigated using the D-function and a Cuzick-Edward's test. Spatial clusters were evaluated using a spatial relative risk surface and the spatial scan statistic using a Bernoulli model. Space-time clustering was explored using a space-time K-function and Knox's test. Space-time clusters were evaluated using a space-time permutation model in SaTScan. Of 955 households with questionnaire data, 33.4% were classified as cases. The statistical significance of space and space-time clustering differed between methods employed. The risk factors associated with occurrence of cases were higher numbers of sows and finishing pigs (log 2 transformed), receiving pigs from an external source and the interaction between using 'water green crop' (WGC) as pig feed and owning ducks with or without direct contact with pigs. The interaction between the presence of ducks and feeding WGC to pigs suggested the involvement of pathogens that might be present in water (environment) and could further replicate in or on ducks.

Objective – To assess the relationship between total plasma protein (TPP) as measured by refractometry and serum hypoalbuminemia and hypoproteinemia in hospitalized dogs. Design – Retrospective, observational study conducted over 6-month period between March and August 2008. Setting – University teaching hospital. Animals – Four hundred and three hospitalized dogs in an ICU. Interventions – None. Measurements and Main Results – TPP, serum albumin, total protein, glucose, urea, cholesterol was measured from dogs enrolled in study. TPP was evaluated as a predictor for hypoalbuminemia defined both as albumin 95% specificity, although sensitivity was poor. Refractometer TPP

In Tamil Nadu, India, improvements have been made toward developing a high-quality, universally accessible healthcare system. However, some rural residents continue to confront significant barriers to obtaining healthcare. The primary objective of this study was to investigate self-reported morbidity, health literacy, and healthcare preferences, utilization, and experiences in order to identify priority areas for government health policies and programs. Drawing on 66 semi-structured interviews and 300 household surveys (including 1693 individuals), administered in 26 rural villages in Tamil Nadu's Krishnagiri district, we found that the prevalence of self-reported major health conditions was 22.3%. There was a large burden of non-communicable and chronic diseases, and the most common major morbidities were: connective tissue problems (7.6%), nervous system and sense organ diseases (5.0%), and circulatory and respiratory diseases (2.5%). Increased age and decreased education level were associated with higher odds of reporting most diseases. Low health literacy levels resulted in individuals seeking care only once pain interfered with daily activities. As such, individuals' health-seeking behaviour depended on which strategy was believed to result in the fastest return to work using the fewest resources. Although government facilities were the most common healthcare access point, they were mistrusted; 48.8% and 19.2% of respondents perceived inappropriate treatment protocols and corruption, respectively, at public facilities. Conversely, 93.3% of respondents reported high treatment cost as the main barrier to accessing private facilities. Our results highlight that addressing the chronic and non-communicable disease burdens amongst rural populations in this context will require health policies and village-level programs that address the low health literacy and the issues of rural healthcare accessibility and acceptability.

Background Overweight, obesity, and related chronic diseases are becoming serious public health concerns in rural areas of India. Compounded with the existing issue of underweight, such concerns expose the double burden of disease and may put stress on rural healthcare. The purpose of this article was to present the prevalence and factors associated with underweight, overweight, and obesity in an area of rural south India. Methods During 2013 and 2014, a random sample of adults aged 20–80 years were selected for participation in a cross-sectional study that collected information on diet (using a food frequency questionnaire), physical activity (using the Global Physical Activity Questionnaire), socioeconomic position (using a wealth index), rurality (using the MSU rurality index), education, and a variety of descriptive factors. BMI was measured using standard techniques. Using a multivariate linear regression analysis and multivariate logistic regression analyses, we examined associations between BMI, overweight, obesity, and underweight, and all potential risk factors included in the survey. Results Age and sex-adjusted prevalence of overweight, obesity class I, and obesity class II were 14.9, 16.1, and 3.3 % respectively. Prevalence of underweight was 22.7 %. The following variables were associated with higher BMI and/or increased odds of overweight, obesity class I, and/or obesity class II: Low physical activity, high wealth index, no livestock, low animal fat consumption, high n-6 polyunsaturated fat consumption, television ownership, time spent watching television, low rurality index, and high caste. The following variables were associated with increased odds of underweight: low wealth index, high rurality index, and low intake of n-6 PUFAs. Conclusion Underweight, overweight, and obesity are prevalent in rural regions of southern India, indicating a village-level dual burden. A variety of variables are associated with these conditions, including physical activity, socioeconomic position, rurality, television use, and diet. To address the both underweight and obesity, policymakers must simultaneously focus on encouraging positive behaviour through education and addressing society-level risk factors that inhibit individuals from achieving optimal health.

Objective: The objectives were to determine whether cooking food with an iron ingot increases the hemoglobin and serum ferritin of women and whether women would use an iron ingot shaped like a fish considered lucky in Cambodian culture. Methods: A randomized controlled trial was conducted in three villages in rural Kandal Province, Cambodia. Participants were randomly assigned to the iron ingot, the iron ingot plus nutrition education, or untreated control group. Participants were instructed to use the iron ingot daily by adding it to the cooking pot when preparing soup or boiling drinking water and boiling for at least 10 minutes. Blood samples were taken at baseline and every three months thereafter, over a 12-month trial period. Results: Overall, a 46% reduction in the prevalence of anemia within the intervention group was noted at the end of the study. Hemoglobin concentrations were greater by 11.8 g/L (95% CI: 9.1, 14.6; P

Background Education is a key element in the socioeconomic development required to improve quality of life in Kenya. Despite the introduction of free primary education, primary school enrollment and attendance levels remain low. Drawing on qualitative and quantitative data, this study explores the determinants of non-enrollment and absenteeism in rural western Kenya and potential mitigation strategies to address these issues. Methods The study was conducted in Bwaliro village in rural western Kenya. A random sample of 64 students was obtained by blocking the village primary school’s student population according to grade level, gender, and orphan status. Qualitative and quantitative data were collected through interviews with parents, guardians, and key informants, and focus group discussions with students. Quantitative data were compared using chi-square tests, Student’s T-test, and Poisson regressions. Qualitative data were analyzed using thematic content analysis. Results Malaria, menstruation, and lack of money were among the most notable determinants of primary school dropout and absenteeism, and these factors disproportionately impacted orphans and female students. Potential mitigation strategies suggested by the community included provision of malaria treatment or prevention, reduction in education costs, expansion of the established school-feeding program, and provision of sanitary pads. Conclusion Despite free primary education, numerous factors continue to prevent children in rural western Kenya from attending primary school. The findings suggest that interventions should primarily target orphaned and female students. Prior to implementation, suggested mitigation strategies should be assessed for cost-effectiveness.

Background Condom promotion remains a cornerstone of HIV/STI control, but must be informed by evidence of uptake and address disparities in use. This study sought to determine the prevalence of, and demographic, behavioural and relational factors associated with, condom use during insertive and receptive anal intercourse with casual partners among younger gay, bisexual and other men who have sex with men (YMSM) in New Zealand. Methods: The 2006–2011 national HIV behavioural surveillance data for YMSM aged 16–29 years was pooled. Separately for each sexual position, frequent (always/almost always) versus infrequent condom use was regressed onto explanatory variables using manual backward stepwise multivariable logistic regression analysis. Results: Three-quarters of YMSM reported frequent condom use during insertive (76.0%) and receptive (73.8%) anal intercourse. YMSM who were exclusively insertive were more likely to report frequent condom use than versatile YMSM. Factors positively associated with frequent condom use, irrespective of sexual position were: in-person versus web-based recruitment, testing HIV negative versus never testing or testing HIV positive, having no recent sex with women, reporting two to five versus one male sexual partner in the past 6 months, reporting no current regular partner, but if in a regular relationship, reporting a boyfriend-type versus fuckbuddy-type partner, and frequent versus infrequent regular partner condom use. Pacific ethnicity and less formal education were negatively associated with frequent condom use only during receptive anal intercourse. Conclusions: The findings from this study demonstrate that condom norms can be actively established and maintained among YMSM. Condom promotion efforts must increase YMSM’s capacity, agency and skills to negotiate condom use, especially for the receptive partner.

Companion-animal relinquishment is a worldwide phenomenon that leaves companion animals homeless. Knowing why humans make the decision to end their relationship with a companion-animal can help in our understanding of this complex societal issue and can help to develop preventive strategies. A systematic review and meta-analysis was conducted to summarize reasons why dogs are surrendered, and determine if certain study characteristics were associated with the reported proportions of reasons for surrender. Articles investigating one or more reasons for dog surrender were selected from the references of a published scoping review. Two reviewers assessed the titles and abstracts of these articles, identifying 39 relevant articles. From these, 21 articles were further excluded because of ineligible study design, insufficient data available for calculating a proportion, or no data available for dogs. Data were extracted from 18 articles and meta-analysis was conducted on articles investigating reasons for dog surrender to a shelter (n=9) or dog surrender for euthanasia (n=5). Three studies were excluded from meta-analysis because they were duplicate populations. Other reasons for excluding studies from meta-analysis were, (1) the study only investigated reasons for dog re-relinquishment (n=2) and (2) the study sample size was10 (n=1). Two articles investigated reasons for both dog surrender to a shelter and dog surrender for euthanasia. Results of meta-analysis found owner health/illness as a reason for dog surrender to a shelter had an overall estimate of 4.6% (95% CI: 4.1%, 5.2%). For all other identified reasons for surrender there was significant variation in methodology among studies preventing further meta-analysis. Univariable meta-regression was conducted to explore sources of variation among these studies. Country was identified as a significant source of variation (p0.01) among studies reporting behavioural problems as a reason for dog surrender for euthanasia. The overall estimate for studies from Australia was 10% (95% CI: 8.0%, 12.0%; I(2)=15.5%), compared to 16% (95% CI: 15.0%, 18.0%; I(2)=20.2%) for studies from other countries. The present systematic review and meta-analysis highlights the need for further research and standardization of data collection to improve understanding of the reasons for dog relinquishment.

Background Understanding HIV testing behaviour is vital to developing evidence-based policy and programming that supports optimal HIV care, support, and prevention. This has not been investigated among younger gay, bisexual, and other men who have sex with men (YMSM, aged 16-29) in New Zealand. Methods National HIV sociobehavioural surveillance data from 2006, 2008, and 2011 was pooled to determine the prevalence of recent HIV testing (in the last 12 months) among YMSM. Factors associated with recent testing were determined using manual backward stepwise multivariate logistic regression. Results Of 3,352 eligible YMSM, 1,338 (39.9%) reported a recent HIV test. In the final adjusted model, the odds of having a recent HIV test were higher for YMSM who were older, spent more time with other gay men, reported multiple sex partners, had a regular partner for 6-12 months, reported high condom use with casual partners, and disagreed that HIV is a less serious threat nowadays and that an HIV-positive man would disclose before sex. The odds of having a recent HIV test were lower for YMSM who were bisexual, recruited online, reported Pacific Islander or Asian ethnicities, reported no regular partner or one for >3 years, were insertive-only during anal intercourse with a regular partner, and who had less HIV-related knowledge. Conclusion A priority for HIV management should be connecting YMSM at risk of infection, but unlikely to test with appropriate testing services. New generations of YMSM require targeted, culturally relevant health promotion that provides accurate understandings about HIV transmission and prevention.

In the developing countries of Africa, Asia and Latin America, neurocysticercosis is the major cause of adult-onset epilepsy (Garcia et al., 2004; Roman et al., 2000; Garcia et al., 2005; Sarti et al., 1994; Sciutto et al., 2000; Mahajan RC, 1982). In 1992, this form of epilepsy, and the Taenia solium tapeworm was declared a potentially eradicable disease by the International Task Force for Disease Eradication (Aarata et al., 1992; Shantz et al., 1993). However, there are several barriers to eradication such as lack of knowledge, lack of resources, poor hygiene and the fundamental implications of the management of pigs as a source of banking and income generation for the poorest of the poor. This chapter will discuss promising results of an educational program, the fact that the education should include the various actors in the swine industry, and illustrate the need for a broader geographic focus to promote the eradication of epilepsy due to neurocysticercosis.

Taenia solium neurocysticercosis is a major cause of adult-onset epilepsy in developing countries. A questionnaire was administered to 282 Kenyan farmers, followed by a workshop, a second questionnaire, one-on-one training, and a third questionnaire. People who attended workshops were more likely to know how T. solium causes epilepsy in humans in the third visit than the second (P = 0.001). The likelihood that farmers would tether their pigs 100% of the time, limiting exposure to tapeworm eggs, increased after the first (P < 0.001) and second visits (P < 0.001). Farmers were more likely to have heard of Cysticercus cellulosae in the second (P = 0.001) and third visits (P = 0.007), and to know how pigs acquire infection in the second (P = 0.03) and third visits (P = 0.003). Farmers with at least a grade 8 education were more likely to know how T. solium is transmitted to humans in the second (P = 0.001) and third visits (P = 0.009), and were more likely to understand the relationship between epilepsy and T. solium in the second (P = 0.03) and third visits (P = 0.03). Grade 8 education may enhance learning from written material. Workshops followed by individual on-farm training enhanced knowledge acquisition and behavior changes. Training local government extension workers contributed to the sustainability of this project.

Background: More than 3.5 billion people are affected by iron-deficiency anaemia (IDA). Previous studies have shown that the use of iron pots in daily cooking ameliorates IDA. We report a study on the use of a novel treatment to address IDA in rural women in Cambodia, where the use of iron pots is not common. Methods: A community-wide randomized controlled trial was conducted in the village of Preak Ruessei, Kandal Province, Cambodia. Rural women ( n = 189) were enrolled and randomly assigned by household to one of three groups: (i) control, (ii) iron treatment with no follow-up and (iii) iron treatment with follow-up visits to provide IDA education. Haemoglobin, serum iron and C-reactive protein concentrations were measured at baseline, 3 and 6 months. A reusable fish-shaped iron ingot was distributed to the two treatment groups and participants were directed to use them daily for cooking. We hypothesized that iron from the ingot would leach iron into food providing an effective iron source. Results: Blood iron levels were higher in women in the iron fish plus follow-up at 3 months compared with controls, but this was not maintained. At 6 months, haemoglobin and serum iron had fallen in all groups and the proportion of anaemic women had increased. Conclusions: This study shows that the iron ingot was effective in the short but not longer-term against IDA. Though a novel treatment option, further research is warranted to determine bioavailability of leached iron and whether or not the surface area is large enough for sufficient iron leaching.

Epidemiologists use the analyses of large data sets collected for production or economic purposes to research production nonhuman animal welfare issues in the commercial setting. This approach is particularly useful if the welfare issue is rare or hard to reproduce. However, to ensure the information is accurate, it is essential to carefully validate these data. The study used economic data to research in-transit deaths of finishing pigs. The most appropriate model to fit the distribution of the outcome must be selected. A negative binomial model fit these data because the prevalence was low and most lots of pigs had no deaths. The study used hierarchical dummy variables to identify thresholds of temperature and humidity above which in-transit losses increased. Multiple variable modeling provides the foundation for the strength of epidemiological research. The model identifies the association between each factor and the outcome after controlling for the other factors in the model. The study evaluated confounding and interaction. Bias may be introduced when data are limited to one farm system, one abattoir, or one season. Census data enable us to understand the entire industry.

Illness can result in compromised welfare and altered needs for the sick nonhuman animal. This research was done to determine alterations in the daily routine of groups of young pigs containing an ...

Current challenges relating to water governance in Canada are motivating calls for approaches that implement Indigenous and Western knowledge systems together, as well as calls to form equitable partnerships with Indigenous Peoples grounded in respectful Nation-to-Nation relationships. By foregrounding the perspectives of First Nations, Inuit, and Métis peoples, this study explores the nature and dimensions of Indigenous ways of knowing around water and examines what the inclusion of Indigenous voices, lived experience, and knowledge mean for water policy and research. Data were collected during a National Water Gathering that brought together 32 Indigenous and non-Indigenous water experts, researchers, and knowledge holders from across Canada. Data were analyzed thematically through a collaborative podcasting methodology, which also contributed to an audio-documentary podcast (www.WaterDialogues.ca).

Background Porcine reproductive and respiratory syndrome (PRRS) is of major concern to the swine industry; infection with the virus can lead to production losses, morbidity, and mortality within swine operations. Biosecurity practices related to the management of replacement animals are important for the prevention and control of the PRRS virus, as well as other diseases. The objectives of this study were: (i) to describe individual biosecurity practices related to the introduction and transportation of replacement gilts on southern Ontario sow farms, and (ii) to understand patterns in the implementation of these practices. The second objective was accomplished using multiple correspondence analysis (MCA), which allows visualization of the relationships between individual practices and provides information about which practices frequently occur together, and which practices rarely occur together. These patterns constitute strategies for the implementation of biosecurity practices related to the introduction and transportation of replacement gilts. Data were collected using version 2 of the Production Animal Disease Risk Assessment Program’s survey for the breeding herd. Two subsets of variables were retained for analysis; one subset pertained to how replacements were managed upon arrival to the farm, and the other pertained to the transportation of genetic animals. Results For both subsets of variables, the results of the MCA procedure were similar; in both solutions the 1st dimension separated herds that were closed with respect to replacement animals from herds that were open, and the 2nd dimension described how open herds managed replacements. The most interesting finding of this study was that, in some cases where a risky practice was being implemented, it was closely associated with other biosecurity practices that may mitigate that risk. Conclusions The findings from this approach suggest that one cannot always examine biosecurity on a variable-by-variable basis. Even if a practice that is generally considered high-risk is being implemented, it may be balanced by other practices that mitigate that risk. Thus, the overall biosecurity strategy on a farm must be considered instead of only examining the implementation of individual practices.

Background The spread of PRRSV among pig herds has been investigated experimentally, but few observational studies have investigated this subject. Because PRRSV is endemic and live modified vaccines are used in Ontario, the spatial and temporal distributions of 6 PRRSV genotypes were investigated in the province during the period from 2004–2007. The purpose was to find evidence of spread of PRRSV genotypes and determine if spread could be attributed to supplier or ownership connections between herds. Sequence information from PRRSV ORF5 and related source-herd demographic information were obtained from diagnostic submissions to the Animal Health Laboratory, University of Guelph. Results A spatial cluster that could not be attributed to supplier or ownership connections among herds in the cluster was detected for RFLP type 1-3-4. Because of genetic dissimilarity among members of the cluster, it was considered to be a result of past spread of the RFLP type. A spatio-temporal cluster detected for RFLP type 1-18-4 was attributed to a shared gilt supplier among the herds in the cluster. Significant spatio-temporal patterns detected for RFLP type 2-5-2, which is considered to be a vaccine-type virus were most likely due to grouping of herds in an ownership that used the corresponding vaccine. Clustering within herd-ownership was a risk factor for presence of five of the six genotypes investigated in the present study. Conclusions Although the literature indicates that PRRSV can spread via aerosol between pig herds, the present study found no strong evidence of this occurring in Ontario. The evidence pointed toward transmission of PRRSV occurring in this population by common sources of animals or similarity of herd ownership, which is a proxy measure for other connections between herds. It is also apparent that the recognition and testing of these connections between herds is a necessary part of interpreting spatio-temporal patterns of PRRSV genotypes.