Authors' response to comments from Nachman KE et al

Authors' response to comments letter to the editor from Nachman KE et al.

What's in a Name? The Incorrect Use of Case Series as a Study Design Label in Studies Involving Dogs and Cats

BACKGROUND

Study design labels are used to identify relevant literature to address specific clinical and research questions and to aid in evaluating the evidentiary value of research. Evidence from the human healthcare literature indicates that the label "case series" may be used inconsistently and inappropriately.

OBJECTIVE

Our primary objective was to determine the proportion of studies in the canine and feline veterinary literature labeled as case series that actually corresponded to descriptive cohort studies, population-based cohort studies, or other study designs. Our secondary objective was to identify the proportion of case series in which potentially inappropriate inferential statements were made.

DESIGN

Descriptive evaluation of published literature.

PARTICIPANTS

One-hundred published studies (from 19 journals) labeled as case series.

METHODS

Studies were identified by a structured literature search, with random selection of 100 studies from the relevant citations. Two reviewers independently characterized each study, with disagreements resolved by consensus.

RESULTS

Of the 100 studies, 16 were case series. The remaining studies were descriptive cohort studies (35), population-based cohort studies (36), or other observational or experimental study designs (13). Almost half (48.8%) of the case series or descriptive cohort studies, with no control group and no formal statistical analysis, included inferential statements about the efficacy of treatment or statistical significance of potential risk factors.

CONCLUSIONS

Authors, peer-reviewers, and editors should carefully consider the design elements of a study to accurately identify and label the study design. Doing so will facilitate an understanding of the evidentiary value of the results.

Updated systematic review: associations between proximity to animal feeding operations and health of individuals in nearby communities

OBJECTIVE

The objective of this review was to update a systematic review of associations between living near an animal feeding operation (AFO) and human health.

METHODS

The MEDLINE® and MEDLINE® In-Process, Centre for Agricultural Biosciences Abstracts, and Science Citation Index databases were searched. Reference lists of included articles were hand-searched. Eligible studies reported exposure to an AFO and an individual-level human health outcome. Two reviewers performed study selection and data extraction.

RESULTS

The search returned 3702 citations. Sixteen articles consisting of 10 study populations were included in the analysis. The health outcomes were lower and upper respiratory tracts, MRSA, other infectious disease, neurological, psychological, dermatological, otologic, ocular, gastrointestinal, stress and mood, and other non-infectious health outcomes. Most studies were observational and used prevalence measures of outcome. An association between Q fever risk and proximity to goat production was reported. Other associations were unclear. Risk of bias was serious or critical for most exposure-outcome associations. Multiplicity (i.e., a large number of potentially correlated outcomes and exposures assessed on the same study subjects) was common in the evidence base.

CONCLUSIONS

Few studies reported an association between surrogate clinical outcomes and AFO proximity for respiratory tract-related outcomes. There were no consistent dose-response relationships between surrogate clinical outcome and AFO proximity. A new finding was that Q fever in goats is likely associated with an increased Q fever risk in community members. The review results for the non-respiratory health outcomes were inconclusive because only a small number of studies were available or the between-study results were inconsistent.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014010521.

Methods and processes of developing the strengthening the reporting of observational studies in epidemiology - veterinary (STROBE-Vet) statement

BACKGROUND

The reporting of observational studies in veterinary research presents many challenges that often are not adequately addressed in published reporting guidelines.

OBJECTIVE

To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety.

DESIGN

A consensus meeting of experts was organized to develop an extension of the STROBE statement to address observational studies in veterinary medicine with respect to animal health, animal production, animal welfare, and food safety outcomes.

SETTING

Consensus meeting May 11-13, 2014 in Mississauga, Ontario, Canada.

PARTICIPANTS

Seventeen experts from North America, Europe, and Australia attended the meeting. The experts were epidemiologists and biostatisticians, many of whom hold or have held editorial positions with relevant journals.

METHODS

Prior to the meeting, 19 experts completed a survey about whether they felt any of the 22 items of the STROBE statement should be modified and if items should be added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. At the meeting, the participants were provided with the survey responses and relevant literature concerning the reporting of veterinary observational studies. During the meeting, each STROBE item was discussed to determine whether or not re-wording was recommended, and whether additions were warranted. Anonymous voting was used to determine whether there was consensus for each item change or addition.

RESULTS

The consensus was that six items needed no modifications or additions. Modifications or additions were made to the STROBE items numbered: 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding).

LIMITATION

Published literature was not always available to support modification to, or inclusion of, an item.

CONCLUSION

The methods and processes used in the development of this statement were similar to those used for other extensions of the STROBE statement. The use of this extension to the STROBE statement should improve the reporting of observational studies in veterinary research related to animal health, production, welfare, or food safety outcomes by recognizing the unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.

A protocol for a systematic literature review: comparing the impact of seasonal and meteorological parameters on acute respiratory infections in Indigenous and non-Indigenous peoples

BACKGROUND

Acute respiratory infections (ARI) are a leading cause of morbidity and mortality globally, and are often linked to seasonal and/or meteorological conditions. Globally, Indigenous peoples may experience a different burden of ARI compared to non-Indigenous peoples. This protocol outlines our process for conducting a systematic review to investigate whether associations between ARI and seasonal or meteorological parameters differ between Indigenous and non-Indigenous groups residing in the same geographical region.

METHODOLOGY

A search string will be used to search PubMed^®, CAB Abstracts/CAB Direct^©, and Science Citation Index^® aggregator databases. Articles will be screened using inclusion/exclusion criteria applied first at the title and abstract level, and then at the full article level by two independent reviewers. Articles maintained after full article screening will undergo risk of bias assessment and data will be extracted. Heterogeneity tests, meta-analysis, and forest and funnel plots will be used to synthesize the results of eligible studies.

DISCUSSION AND REGISTRATION

This protocol paper describes our systematic review methods to identify and analyze relevant ARI, season, and meteorological literature with robust reporting. The results are intended to improve our understanding of potential associations between seasonal and meteorological parameters and ARI and, if identified, whether this association varies by place, population, or other characteristics. The protocol is registered in the PROSPERO database (#38051).

Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement

Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines. Our objective was to develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety. We conducted a consensus meeting with 17 experts in Mississauga, Canada. Experts completed a premeeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended, and whether additions were warranted. Anonymous voting was used to determine consensus. Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources and measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding). The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food-producing and companion animals, products of animal origin, aquaculture, and wildlife.

Explanation and Elaboration Document for the STROBE-Vet Statement: Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary Extension

The STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement was first published in 2007 and again in 2014. The purpose of the original STROBE was to provide guidance for authors, reviewers, and editors to improve the comprehensiveness of reporting; however, STROBE has a unique focus on observational studies. Although much of the guidance provided by the original STROBE document is directly applicable, it was deemed useful to map those statements to veterinary concepts, provide veterinary examples, and highlight unique aspects of reporting in veterinary observational studies. Here, we present the examples and explanations for the checklist items included in the STROBE-Vet statement. Thus, this is a companion document to the STROBE-Vet statement methods and process document (JVIM_14575 "Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology-Veterinary (STROBE-Vet) Statement" undergoing proofing), which describes the checklist and how it was developed.

Methods and Processes of Developing the Strengthening the Reporting of Observational Studies in Epidemiology - Veterinary (STROBE-Vet) Statement

Background

Reporting of observational studies in veterinary research presents challenges that often are not addressed in published reporting guidelines.

Objective

To develop an extension of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement that addresses unique reporting requirements for observational studies in veterinary medicine related to health, production, welfare, and food safety.

Design

Consensus meeting of experts.

Setting

Mississauga, Canada.

Participants

Seventeen experts from North America, Europe, and Australia.

Methods

Experts completed a pre‐meeting survey about whether items in the STROBE statement should be modified or added to address unique issues related to observational studies in animal species with health, production, welfare, or food safety outcomes. During the meeting, each STROBE item was discussed to determine whether or not rewording was recommended and whether additions were warranted. Anonymous voting was used to determine consensus.

Results

Six items required no modifications or additions. Modifications or additions were made to the STROBE items 1 (title and abstract), 3 (objectives), 5 (setting), 6 (participants), 7 (variables), 8 (data sources/measurement), 9 (bias), 10 (study size), 12 (statistical methods), 13 (participants), 14 (descriptive data), 15 (outcome data), 16 (main results), 17 (other analyses), 19 (limitations), and 22 (funding).

Conclusion

The methods and processes used were similar to those used for other extensions of the STROBE statement. The use of this STROBE statement extension should improve reporting of observational studies in veterinary research by recognizing unique features of observational studies involving food‐producing and companion animals, products of animal origin, aquaculture, and wildlife.

Clinical trial on the effects of a free-access acidified milk replacer feeding program on the health and growth of dairy replacement heifers and veal calves

The objectives of this study were to evaluate the effects of free-access acidified milk replacer feeding on the pre- and postweaning health of dairy and veal calves. Individually housed calves were systematically assigned at birth to 1 of 2 feeding programs: free-access feeding (ad libitum) of acidified milk replacer (ACD, n=249) or traditional restricted feeding (3L fed twice daily) of milk replacer (RES, n=249). Calves were fed milk replacer containing 24% crude protein and 18% fat. Acidified milk replacer was prepared to a target pH between 4.0 and 4.5 using formic acid. Calves were weaned off milk replacer at approximately 6wk of age. Weaning occurred over 5d, and during this weaning period, ACD calves had access to milk replacer for 12h/d and RES calves were offered only one feeding of milk replacer (3 L) daily. Calves were monitored daily for signs of disease. Fecal consistency scores were assigned each week from birth until weaning. A subset of calves was systematically selected for fecal sampling at 3 time points between 7 and 27d of age. Fecal samples were analyzed for enterotoxigenic Escherichia coli F5, Cryptosporidium parvum, rotavirus, and coronavirus. Hip width, hip height, body length, heart girth, and body weight were measured at birth and weaning. Postweaning body weight measurements were collected from the heifers at approximately 8mo of age. Postweaning body weight and carcass grading information was collected from the veal calves at slaughter once a live weight between 300 and 350kg had been achieved. The odds of ACD calves being treated for a preweaning disease event tended to be lower than that of the RES calves (1.2 vs. 5.2%, respectively). Preweaning mortality, postweaning disease treatment, and postweaning mortality did not differ between feeding treatments. The ACD feeding treatment supported greater preweaning average daily gain (0.59 vs. 0.43kg/d) and structural growth than RES feeding. Postweaning average daily gain and carcass characteristics were similar for ACD and RES calves. These results indicate that free-access acidified milk replacer feeding tended to support improved health, and greater body weight gain and structural growth during the preweaning period; these effects did not persist in the postweaning period. The growth advantage observed before weaning in the ACD calves likely disappeared due to the weaning methods used.

Owned dog ecology and demography in Villa de Tezontepec, Hidalgo, Mexico

Dog overpopulation in developing countries has negative implications for the health and safety of people, including the transmission of zoonotic diseases, physical attacks and intimidation to humans and animals, as well as impacts on canine welfare. Understanding the ecology and demographic characteristics of a dog population can help in the planning and monitoring of canine population control programs. Little data exist regarding demography and dynamics of domestic dog populations in semi-urban areas in Mexico. A cross-sectional study was carried out between October 21 and November 7, 2015, to characterize the dog ecology and demography in Villa de Tezontepec, Hidalgo, Mexico. A face-to-face survey was used to collect data from randomly selected households in four contiguous communities using stratified two-stage cluster sampling. Within each household, adults answered questions related to their dogs and their experiences with dog bites and aggression. A total of 328 households were interviewed, representing a participation rate of 90.9% (328/361) and 1,450 people. Approximately 65.2% of the households owned one or more dogs, with a mean of 1.3 (SD=1.5) and 2.0 (SD=1.5) owned dogs in all participant households and dog-owning households, respectively. The human: owned dog ratio for all participant households was 3.4:1 (1450/428), and for the dog-owning households was 2.3:1 (984/428). The owned dog male: female ratio was 1.4:1 (249/179). Approximately 74.4% (95.0% CI=69.8% - 78.7%) of the owned dogs were older than one year (mean age: 2.9 years; SD=2.5). The mean age of owned female dogs at first litter was 1.9 years (SD=1.2) and the mean litter size was 4.2 puppies (SD=2.1). Approximately 36.9% (95.0% CI=31.8% - 46.4%) of the females were spayed, and 14.1% (95.0% CI=10.7% - 19.7%) of the males were neutered. Only 44.9% (95.0% CI=40.1% - 49.7%) were always confined when unsupervised. Approximately 84.4% (95.0% CI=80.6% - 87.7%) were reported to have been vaccinated against rabies in 2015. The knowledge of owned dog demography and ecology provided by this study can inform local government planning of dog population control interventions, and could serve as a baseline for the development of agent-based models to evaluate the effects of different dog population control strategies on dog demography.

The case-control design in veterinary sciences: A survey

The case-control study design is deceptively simple. However, many design considerations influence the estimated effect measure. An investigation of case-control studies in the human health literature suggested that some of these considerations are not described in reports of case-control studies. Our hypothesis was that the majority of veterinary studies labeled as case-controls would be incident density designs, and many would not interpret the effect measure obtained from those studies as the rate ratio rather than the odds ratio. Reference databases were searched for author-designated case-control studies. A survey of 100 randomly selected studies was conducted to examine the different design options described and estimated effect measures. Of the 100 author-identified case-control studies, 83 assessed an exposure-outcome association and, of those, only 54 (65.1%) sampled the study population based on an outcome and would thus be considered case-control designs. Twelve studies were incidence density designs but none used this terminology. Of the studies that reported an odds ratio as the effect measure, none reported on additional considerations that would have enabled a more interpretable result. This survey indicated many case-control-labeled studies were not case-control designs and among case-control studies, key design aspects were not often described. The absence of information about study design elements and underlying assumptions in case-control studies limits the ability to establish the effect measured by the study and the evidentiary value of the study might be underestimated.

Detection of Escherichia Coli O157:H7 in Cattle Feces Using a Polymerase Chain Reaction—Based Fluorogenic 5′ Nuclease (TaqMan®) Detection Assay after Secondary Enrichment

Currently, methods for recovering and identifying Escherichia coli O157:H7 from cattle feces are inconsistent and hindered by their inability to specifically and rapidly detect small numbers of organisms from this complex and highly variable matrix. A standard approach for isolating and characterizing E. coli O157:H7 from cattle feces was compared with a polymerase chain reaction (PCR)-based 5′ nuclease assay specific for E. coli O157:H7 that included a secondary enrichment step. The PCR-based method proved a better indicator of the presence of the organism than the culture procedure. Retests indicated that the inclusion of a secondary enrichment step and the subsequent analysis by the 5′ nuclease assay were reproducible and specific. Escherichia coli O157:H7 could be detected in fecal samples that were otherwise negative after a primary enrichment step, immunomagnetic separation, and plating onto sorbitol MacConkey agar plates containing cefixime and tellurite (CT-SMAC). In samples that were initially identified as culture positive but PCR negative, retesting of the culture isolates on CT-SMAC indicated that the sorbitol fermentation interpretations could frequently not be repeated in retests, whereas retesting using the 5′ nuclease assay on the original samples demonstrated a high level of agreement with the initial PCR conclusions. These results indicate the necessity of confirmatory evaluation of isolates culturally recovered by standard cultural methods that involve the interpretation of CT-SMAC. The high level of disagreement between initial culture results and retests, and the high level of agreement between initial PCR results and retests, indicates the advantages of a gene-based detection system for identifying E. coli O157:H7 in cattle feces. Screening large numbers of fecal samples for E. coli O157:H7 would appear to be feasible by integrating the use of enrichment media in serial rounds of incubation with a PCR-based fluorogenic detection procedure in high throughput detection systems that had automated liquid-handling capabilities.

Implications of applying methodological shortcuts to expedite systematic reviews: three case studies using systematic reviews from agri-food public health

Background

The rapid review is an approach to synthesizing research evidence when a shorter timeframe is required. The implications of what is lost in terms of rigour, increased bias and accuracy when conducting a rapid review have not yet been elucidated.

Methods

We assessed the potential implications of methodological shortcuts on the outcomes of three completed systematic reviews addressing agri‐food public health topics. For each review, shortcuts were applied individually to assess the impact on the number of relevant studies included and whether omitted studies affected the direction, magnitude or precision of summary estimates from meta‐analyses.

Results

In most instances, the shortcuts resulted in at least one relevant study being omitted from the review. The omission of studies affected 39 of 143 possible meta‐analyses, of which 14 were no longer possible because of insufficient studies (<2). When meta‐analysis was possible, the omission of studies generally resulted in less precise pooled estimates (i.e. wider confidence intervals) that did not differ in direction from the original estimate.

Conclusions

The three case studies demonstrated the risk of missing relevant literature and its impact on summary estimates when methodological shortcuts are applied in rapid reviews. © 2016 The Authors. Research Synthesis Methods Published by John Wiley & Sons Ltd.

Development of a tiered framework for public health capacity in Canada

•

Select SARS reports were qualitatively analyzed for usage of “capacity”/“capacities”.

•

Public health capacity can be sub-divided into 17 individual capacity components.

•

These components can be organized into five tiers to build a capacity framework.

•

This framework can be used to guide capacity assessment and building efforts.

Exploring the Impact of Toxic Attitudes and a Toxic Environment on the Veterinary Healthcare Team

The objective of this qualitative study was to compare veterinarians' and Registered Veterinary Technicians' (RVT's) perceptions of the veterinary healthcare team with respect to the impact of toxic attitudes and a toxic environment. Focus group interviews using a semi-structured interview guide and follow up probes were held with four veterinarian groups (23 companion animal veterinarians) and four Registered Veterinary Technician groups (26 RVTs). Thematic analysis of the discussions indicated both veterinarian and RVT participants felt team members with manifestations of toxic attitudes negatively impacted veterinary team function. These manifestations included people being disrespectful, being resistant to change, always wanting to be the "go to person," avoiding conflict, and lacking motivation. When conflict was ignored, or when people with toxic attitudes were not addressed, a toxic environment often resulted. A toxic environment sometimes manifested when "broken communication and tension between staff members" occurred as a result of employees lacking confidence, skills, or knowledge not being managed properly. It also occurred when employees did not feel appreciated, when there was difficulty coping with turnover, and when there were conflicting demands. The presence of people manifesting a toxic attitude was a source of frustration for both veterinarian and RVT participants. Prompt and consistent attention to negative behaviors is recommended to reduce the development of a toxic environment.

Critical appraisal of studies using laboratory animal models

In this manuscript we discuss an approach to critically appraising papers based on the results of laboratory animal experiments. The roles of external and internal validity in critically appraising the results of a paper are introduced. The risk of bias domains used by the Cochrane Handbook of Systematic Reviews of Interventions form the basis for assessing internal validity. The bias domains discussed include the selection bias, performance bias, outcome assessment bias, attrition bias, and reporting bias. Further, an approach to considering the role of chance in research findings is discussed.

Area-level global and local clustering of human Salmonella Enteritidis infection rates in the city of Toronto, Canada, 2007-2009

BACKGROUND

Salmonella enterica serotype Enteritidis (S. Enteritidis) remains a major foodborne pathogen in North America yet studies examining the spatial epidemiology of salmonellosis in urban environments are lacking. Our ecological study combined a number of spatial statistical methods with a geographic information system to assess area-level heterogeneity of S. Enteritidis infection rates in the city of Toronto.

METHODS

Data on S. Enteritidis infections between January 1, 2007 and December 31, 2009 were obtained from Ontario's surveillance system, and were grouped and analyzed at the forward sortation area (FSA)-level (an area signified by the first three characters of the postal code). Incidence rates were directly standardized using the FSA-level age- and sex-based standard population. A spatial empirical Bayes method was used to smooth the standardized incidence rates (SIRs). Global clustering of FSAs with high or low non-smoothed SIRs was evaluated using the Getis-Ord G method. Local clustering of FSAs with high, low, or dissimilar non-smoothed SIRs was assessed using the Getis-Ord Gi* and the Local Moran's I methods.

RESULTS

Spatial heterogeneity of S. Enteritidis infection rates was detected across the city of Toronto. The non-smoothed FSA-level SIRs ranged from 0 to 16.9 infections per 100,000 person-years (mean = 6.6), whereas the smoothed SIRs ranged from 2.9 to 11.1 (mean = 6.3). The global Getis-Ord G method showed significant (p ≤ 0.05) maximum spatial clustering of FSAs with high SIRs at 3.3 km. The local Getis-Ord Gi* method identified eight FSAs with significantly high SIRs and one FSA with a significantly low SIR. The Local Moran's I method detected five FSAs with significantly high-high SIRs, one FSA with a significantly low-low SIR, and four significant outlier FSAs (one high-low, and three low-high).

CONCLUSIONS

Salmonella Enteritidis infection rates clustered globally at a small distance band, suggesting clustering of high SIRs in small distinct areas. This finding was supported by the local cluster analyses, where distinct FSAs with high SIRs, mainly in downtown Toronto, were detected. These areas should be evaluated by future studies to identify risk factors of disease in order to implement targeted prevention and control programs. We demonstrated the usefulness of combining several spatial statistical techniques with a geographic information system to detect geographical areas of interest for further study, and to evaluate spatial processes that influenced S. Enteritidis infection rates. Our study methodology could be applied to other foodborne disease surveillance data.

Conducting systematic reviews of intervention questions I: Writing the review protocol, formulating the question and searching the literature

This article is the fourth of six articles addressing systematic reviews in animal agriculture and veterinary medicine. Previous articles in the series have introduced systematic reviews, discussed study designs and hierarchies of evidence, and provided details on conducting randomized controlled trials, a common design for use in systematic reviews. This article describes development of a review protocol and the first two steps in a systematic review: formulating a review question, and searching the literature for relevant research. The emphasis is on systematic reviews of questions related to interventions. The review protocol is developed prior to conducting the review and specifies the plan for the conduct of the review, identifies the roles and responsibilities of the review team and provides structured definitions related to the review question. For intervention questions, the review question should be defined by the PICO components: population, intervention, comparison and outcome(s). The literature search is designed to identify all potentially relevant original research that may address the question. Search terms related to some or all of the PICO components are entered into literature databases, and searches for unpublished literature also are conducted. All steps of the literature search are documented to provide transparent reporting of the process.

Introduction to systematic reviews in animal agriculture and veterinary medicine

This article is the first in a series of six articles related to systematic reviews in animal agriculture and veterinary medicine. In this article, we overview the methodology of systematic reviews and provide a discussion of their use. Systematic reviews differ qualitatively from traditional reviews by explicitly defining a specific review question, employing methods to reduce bias in the selection and inclusion of studies that address the review question (including a systematic and specified search strategy, and selection of studies based on explicit eligibility criteria), an assessment of the risk of bias for included studies and objectively summarizing the results qualitatively or quantitatively (i.e. via meta-analysis). Systematic reviews have been widely used to address human healthcare questions and are increasingly being used in veterinary medicine. Systematic reviews can provide veterinarians and other decision-makers with a scientifically defensible summary of the current state of knowledge on a topic without the need for the end-user to read the vast amount of primary research related to that topic.

The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics

OBJECTIVE

To determine the role of veterinary team effectiveness regarding job satisfaction and burnout in companion animal veterinary practice.

DESIGN

Cross-sectional observational study.

SAMPLE

48 companion animal veterinary health-care teams.

PROCEDURES

274 team members participated in an online survey. Overall job satisfaction was evaluated with a 1-item measure, and the 3 dimensions of burnout (exhaustion, cynicism, and professional efficacy) were measured with the Maslach Burnout Inventory-General Survey. Team effectiveness was assessed with a survey developed for this study. Demographic and team effectiveness factors (coordinated team environment, toxic team environment, team engagement, and individual engagement) associated with job satisfaction and burnout were evaluated.

RESULTS

Overall mean job satisfaction score was 5.46 of 7 (median, 6.00); veterinary technicians and kennel attendants had the lowest scores. According to the Maslach survey results, 22.4% of participants were in the high-risk category for exhaustion, 23.2% were in the high-risk category for cynicism, and 9.3% were in the high-risk category for professional efficacy. A coordinated team environment was associated with increased professional efficacy and decreased cynicism. A toxic team environment was negatively associated with job satisfaction and positively associated with exhaustion and cynicism. Individual engagement was positively associated with job satisfaction and professional efficacy and negatively associated with exhaustion and cynicism.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggested the effectiveness of a veterinary team can significantly influence individual team members' job satisfaction and burnout. Practices should pay specific attention to the effectiveness with which their veterinary team operates.

Conducting systematic reviews of intervention questions II: Relevance screening, data extraction, assessing risk of bias, presenting the results and interpreting the findings

This is the fifth in a series of six articles describing systematic reviews in animal agriculture and veterinary medicine. The previous articles in this series overviewed the development of a review protocol and the initial steps in conducting a systematic review: identification of a structured question to be answered and conducting a comprehensive literature search to find potentially relevant original research to address the review question. This article describes relevance screening of literature identified in the search to determine which of the original research articles are relevant to the review question, data extraction from primary research studies, the use of standardized procedures to assess the risk of bias in the relevant research studies, presenting the results of the body of research identified and interpreting these results.

A systematic review and meta-analysis of the proportion of dogs surrendered for dog-related and owner-related reasons

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 was <10 (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 (p<0.01) 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.

The association between proximity to animal-feeding operations and community health: a protocol for updating a systematic review

BACKGROUND

Livestock and poultry operations that feed large numbers of animals are common. Facility capacity varies, but it is not uncommon for facilities to house 1,000 swine with multiple barns at a single site, feedlots to house 50,000 cattle, and poultry houses to house 250,000 hens. There is primary research that suggests livestock facilities that confine animals indoors for feeding can represent a health hazard for surrounding communities. In this protocol, we describe a review about the association between proximity to animal-feeding operations (AFOs) and the health of individuals in nearby communities. A systematic review of the topic was published by some members of our group in 2010. The purpose of this review is to update that review.

METHODS/DESIGN

The populations of interest are people living in communities near livestock production facilities. Outcomes of interest are any health outcome measured in humans such as respiratory disease, gastrointestinal disease, and mental health. Measures of antibiotic resistance in people from the communities compared to measures of resistance found in animals and the environment on animal-feeding operations will also be summarized. The exposure of interest will be exposure to livestock production using a variety of metrics such as distance from facilities, endotoxin levels, and measures of odor. Electronic searches will be conducted using MEDLINE and MEDLINE In-Process (via OvidSP), CAB Abstracts (via Web of Knowledge), and Science Citation Index (via Web of Knowledge). No language or date restriction will be applied. We will access the risk of bias using a pilot version of a tool developed by the Methods Groups of the Cochrane Collaboration for non-randomized interventions.We propose to conduct a meta-analysis for each health metric (e.g., combining all respiratory disease outcomes, combining all gastrointestinal outcomes). A planned subgroup analysis will be based on the domains of the risk of bias.

DISCUSSION

This systematic review will provide synthesis of current evidence reporting the association between living near an animal-feeding operation and human health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42014010521.

Knowledge, attitudes, and practices related to pet contact by immunocompromised children with cancer and immunocompetent children with diabetes

OBJECTIVE

To compare knowledge, attitudes, and risks related to pet contact in households with and without immunocompromised children.

STUDY DESIGN

A questionnaire was distributed to parents of children diagnosed with cancer (immunocompromised; n=80) or diabetes (immunocompetent; n=251) receiving care at the Children's Hospital of Eastern Ontario. Information was collected on knowledge of pets as sources of disease, concerns regarding pet-derived pathogens, and pet ownership practices. Data were analyzed with multivariable logistic regression.

RESULTS

The questionnaire was completed by 65% (214 of 331) of the individuals to whom it was given. Pet ownership was common; 45% of respondents had a household pet when their child was diagnosed, and many (households with a child with diabetes, 49%; households with a child with cancer, 20%) acquired a new pet after diagnosis. Most households that obtained a new pet had acquired a pet considered high risk for infectious disease based on species/age (diabetes, 73%; cancer, 77%). Parents of children with cancer were more likely than parents of children with diabetes to recall being asked by a physician/staff member if they owned a pet (OR, 5.9) or to recall receiving zoonotic disease information (OR, 5.3), yet these interactions were reported uncommonly (diabetes, ≤13%; cancer, ≤48%). Greater knowledge of pet-associated pathogens was associated with recalled receipt of previous education on this topic (OR, 3.9). Pet exposure outside the home was reported frequently for children in non-pet-owning households (diabetes, 48%; cancer, 25%).

CONCLUSION

Improved zoonotic disease education is needed for pet-owning and non-pet-owning households with immunocompromised children, with ongoing provision of information while the children are at increased risk of disease. Additional efforts from pediatric and veterinary healthcare professionals are required.