Journal Articles

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    Making predictions under interventions: a case study from the PREDICT-CVD cohort in New Zealand primary care
    (Frontiers Media S.A., 2024-04-03) Lin L; Poppe K; Wood A; Martin GP; Peek N; Sperrin M; Piccininni M
    Background: Most existing clinical prediction models do not allow predictions under interventions. Such predictions allow predicted risk under different proposed strategies to be compared and are therefore useful to support clinical decision making. We aimed to compare methodological approaches for predicting individual level cardiovascular risk under three interventions: smoking cessation, reducing blood pressure, and reducing cholesterol. Methods: We used data from the PREDICT prospective cohort study in New Zealand to calculate cardiovascular risk in a primary care setting. We compared three strategies to estimate absolute risk under intervention: (a) conditioning on hypothetical interventions in non-causal models; (b) combining existing prediction models with causal effects estimated using observational causal inference methods; and (c) combining existing prediction models with causal effects reported in published literature. Results: The median absolute cardiovascular risk among smokers was 3.9%; our approaches predicted that smoking cessation reduced this to a median between a non-causal estimate of 2.5% and a causal estimate of 2.8%, depending on estimation methods. For reducing blood pressure, the proposed approaches estimated a reduction of absolute risk from a median of 4.9% to a median between 3.2% and 4.5% (both derived from causal estimation). Reducing cholesterol was estimated to reduce median absolute risk from 3.1% to between 2.2% (non-causal estimate) and 2.8% (causal estimate). Conclusions: Estimated absolute risk reductions based on non-causal methods were different to those based on causal methods, and there was substantial variation in estimates within the causal methods. Researchers wishing to estimate risk under intervention should be explicit about their causal modelling assumptions and conduct sensitivity analysis by considering a range of possible approaches.
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    Lameness recovery rates following treatment of dairy cattle with claw horn lameness in the Waikato region of New Zealand.
    (Taylor and Francis Group, 2023-09-01) Mason W; Laven LJ; Cooper M; Laven RA
    AIMS: To describe the time in days for lame dairy cows to recover after diagnosis and treatment of claw horn lameness, and to investigate whether cure rates differed between farms. METHODS: Five dairy farms in the Waikato region were conveniently enrolled into a descriptive epidemiological study. Three of these farms had dairy cattle enrolled over two consecutive seasons, while two farms enrolled for one year. Lame cattle diagnosed by the farmers were enrolled into the study if they had a lameness score (LS ≥ 2 on a 0-3 scale) and claw horn lesions. All enrolled animals were treated by a single veterinarian following a consistent methodology, and subsequently assessed for LS at a median frequency of 4 days from enrolment until they were sound (LS = 0). The times (days) taken for animals to become sound and non-lame (LS < 2) were reported for all animals, and Kaplan-Meier survival curves used to present the results. A Cox-proportional hazard model was used to assess if the hazard of soundness was associated with farm, age, breed, lesion, number of limbs involved, and LS at enrolment. RESULTS: A total of 241 lame cattle with claw horn lesions were enrolled across the five farms. White line disease was the predominant pain-causing lesion in 225 (93%) animals, and blocks were applied to 205 (85%) of enrolled animals. The overall median days from enrolment to becoming sound was 18 (95% CI = 14-21) days, and 7 (95% CI = 7-8) days to become non-lame. A difference in the hazards of lameness cure between farms was identified (p = 0.007), with median days to lameness cure between farms ranging from 11 to 21 days. No associations were identified between age, breed, limb, or LS at enrolment on the lameness cure rates. CONCLUSIONS: Treatment of claw horn lameness following industry-standard guidelines in dairy cattle on five New Zealand dairy farms resulted in rapid cure, although cure rates differed between farms. CLINICAL RELEVANCE: Following industry best-practice lameness treatment guidelines, including frequent use of blocks, can result in rapid lameness cure rates in New Zealand dairy cows. This study also suggests that management of lame cattle on pasture can positively benefit their welfare and recovery times. The reported cure rates provide veterinarians with benchmarks on the length of time after which a lame animal should be re-examined, and in the investigation of poor treatment response rates at the herd level.
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    Persistence of orthopaedic hoof blocks for the treatment of lame cattle kept permanently at pasture.
    (Taylor and Francis Group, 2023-09-01) Müller KR; Laven RA; Laven LJ
    AIMS: To compare the retention by New Zealand dairy cows kept at pasture in a lame cow group, of three hoof block products commonly used in the remediation of lameness. METHODS: Sixty-seven farmer-presented Friesian and Friesian x Jersey dairy cows from a single herd in the Manawatū region (New Zealand) suffering from unilateral hind limb lameness attributable to a claw horn lesion (CHL) were randomly allocated to one of three treatments: foam block (FB), plastic shoe (PS) and a standard wooden block (WB). Blocks were applied to the contralateral healthy claw and checked daily by the farm staff (present/not present) and date of loss was recorded. Blocks were reassessed on Day 14 and Day 28 and then removed unless further elevation was indicated. Daily walking distances were calculated using a farm map and measurement software. Statistical analyses included a linear marginal model for distance walked until block loss and a Cox regression model for the relative hazard of a block being lost. RESULTS: Random allocation meant that differences between products in proportion used on left or right hind foot or lateral or medial claw were small. Mean distance walked/cow/day on farm tracks whilst the block was present was 0.32 (min 0.12, max 0.45) km/day; no biologically important difference between products in the mean distance walked was identified. Compared to PS, cows in the WB group were five times more likely to lose the block (HR = 4.8 (95% CI = 1.8-12.4)), while cows in the FB group were 9.5 times more likely to lose the block (HR = 9.5 (95% CI = 3.6-24.4)). CONCLUSIONS: In this study, PS were retained for much longer than either FB or WB. As cows were managed in a lame cow group for the study duration, walking distances were low and did not impact on the risk of block loss. More data are needed to define ideal block retention time. CLINICAL RELEVANCE: In cows with CHL the choice of block could be based on the type of lesion present and the expected re-epithelisation times.
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    Farm-level risk factors and treatment protocols for lameness in New Zealand dairy cattle.
    (Taylor and Francis Group, 2024-05-08) Mason WA; Müller KR; Laven LJ; Huxley JN; Laven RA
    Aims To identify farm-level risk factors for dairy cow lameness, and to describe lameness treatment protocols used on New Zealand dairy farms. Methods One hundred and nineteen farms from eight veterinary clinics within the major dairying regions of New Zealand were randomly enrolled into a cross-sectional lameness prevalence study. Each farmer completed a questionnaire on lameness risk factors and lameness treatment and management. Trained observers lameness scored cattle on two occasions, between October–December (spring, coinciding with peak lactation for most farms) and between January–March (summer, late lactation for most farms). A four-point (0–3) scoring system was used to assess lameness, with animals with a lameness score (LS) ≥2 defined as lame. At each visit, all lactating animals were scored including animals that had previously been identified lame by the farmer. Associations between the farmer-reported risk factors and lameness were determined using mixed logistic regression models in a Bayesian framework, with farm and score event as random effects. Results A lameness prevalence of 3.5% (2,113/59,631) was reported at the first LS event, and 3.3% (1,861/55,929) at the second LS event. There was a median prevalence of 2.8% (min 0, max 17.0%) from the 119 farms. Most farmers (90/117; 77%) relied on informal identification by farm staff to identify lame animals. On 65% (75/116) of farms, there was no external provider of lame cow treatments, with the farmer carrying out all lame cow treatments. Most farmers had no formal training (69/112; 62%). Animals from farms that used concrete stand-off pads during periods of inclement weather had 1.45 times the odds of lameness compared to animals on farms that did not use concrete stand-off pads (95% equal-tailed credible interval 1.07–1.88). Animals from farms that reported peak lameness incidence from January to June or all year-round, had 0.64 times odds of lameness compared to animals from farms that reported peak lameness incidence from July to December (95% equal-tailed credible interval 0.47–0.88). Conclusions Lameness prevalence was low amongst the enrolled farms. Use of concrete stand-off pads and timing of peak lameness incidence were associated with odds of lameness. Clinical relevance Veterinarians should be encouraging farmers to have formal lameness identification protocols and lameness management plans in place. There is ample opportunity to provide training to farmers for lame cow treatment. Management of cows on stand-off pads should consider the likely impact on lameness.
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    Evidence-Based Aerobic Exercise Training in Metabolic-Associated Fatty Liver Disease: Systematic Review with Meta-Analysis
    (MDPI (Basel, Switzerland), 2021) Słomko J; Zalewska M; Niemiro W; Kujawski S; Słupski M; Januszko-Giergielewicz B; Zawadka-Kunikowska M; Newton J; Hodges L; Kubica J; Zalewski P
    Background: This meta-analysis evaluates the overall effect of the non-pharmacological intervention, aerobic exercise, upon serum liver enzymes levels, glucose metabolism and anthropometric measures amongst patients with metabolic associated fatty liver disease (MAFLD). It also examines whether the effects on these outcomes are moderated by the aerobic training protocol when considered according to the American College of Sports Medicine (ACSM) recommended FITT (frequency, intensity, time, type) principles. Approach and Results: Fifteen randomized control trials were included in the meta-analysis. Compared with usual care, continuous and interval training showed significant efficacy in alanine aminotransferase (ALT) level improvement (MD = −2.4, 95% CI: −4.34 to −0.46 p = 0.015, I2 = 9.1%). Interventions based on all types of aerobic exercise protocols showed significant improvement of intrahepatic triglycerides (MD = −4.0557, 95% CI: −5.3711 to −2.7403, p < 0.0001, I2 = 0%) and BMI (MD = −0.9774, 95% CI: −1.4086 to −0.5462, p < 0.0001, I2 = 0). Meta-regression analysis demonstrated a significant correlation between total intervention time and ALT level (for all aerobic protocols: 6.0056, se = 2.6896, z = 2.2329, p = 0.02; as well as for continuous and interval aerobic protocols: 5.5069, se = 2.7315, z = 2.016, p = 0.04). Conclusions: All types of aerobic exercise protocols are effective at improving intrahepatic triglycerides and lead to a reduction in body mass index. In addition, continuous and interval aerobic exercise may be more effective at improving ALT ≤12 weeks intervention time benefits the management of MAFLD.