Determinants of inequalities in years with disability: an international-comparative study

Background Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father’s manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption. Methods We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010–14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated (‘upward levelling scenario’), using Population Attributable Fractions. Results Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father’s manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small. Conclusions Disadvantages in material circumstances (low income), circumstances during childhood (father’s manual occupation) and high body-weight contribute to inequalities in years with disability.

Direct Oral Anticoagulant Concentrations in Obese and High Body Weight Patients: A Cohort Study

Background Direct oral anticoagulants (DOACs) are prescribed for atrial fibrillation (AF) and venous thromboembolism (VTE) and both occur more frequently in obese patients. Outcomes from DOAC trials included few individuals ≥ 120 kg leading to uncertainty whether high body weight (BW) reduces DOAC concentrations. Objectives This article investigates the relationship between factor Xa (FXa) inhibitor concentrations, BW, and renal function, and compares them in high BW patients with unselected populations. Methods Consecutive patients in two United Kingdom centers, weighing ≥ 120 kg receiving 5 mg twice daily apixaban or 20 mg once daily rivaroxaban for AF or VTE were prospectively included. Peak or trough concentrations were measured using specific chromogenic assays, expressed in mean or median (5th–95th percentiles). On-therapy range was the interval from the 5th percentile trough concentration to the 95th percentile peak concentration. Results One hundred patients were included; age range: 23 to 78 years, 31% were women, 58% had AF, creatinine clearance range: 67 to 474 mL/min. Median BW was 139 kg, and 84% had body mass index (BMI) ≥ 40 kg/m2. DOAC peak and trough concentrations varied from 44 to 727 and 14 to 299 ng/mL, respectively. There was no linear relationship between FXa inhibitor concentrations at peak or trough and BW or BMI, and creatinine clearance. Apixaban troughs in AF and rivaroxaban peaks in VTE were lower than in unselected populations. However, only two trough concentrations were below the expected range, and 109/116 were within the on-therapy range. Conclusion These data indicated that obese or high BW patients generally achieve therapeutic FXa inhibitor concentrations. However, further investigations assessing clinical outcomes are required.

Cecal microbiota affects chicken growth performance by regulating fat metabolism

Background A growing body of evidences suggest critical role of the chicken gut microbiota in growth performance and fat metabolism. However, the underlying mechanism by which the gut microbiota affects chicken growth performance by regulating fat metabolism remains unclear. The purpose of current study was to compare cecal microbial communities between high and low body weight chickens and verify the correlation between fat metabolism and gut microbiota. Results Seven-week-old male and female chickens with significantly different body weight were used in the present study. 16S rRNA gene sequencing was used to reveal the cecal microbial community. Fat metabolism levels were compared between high and low body weight chickens. Spearman correlation analysis was used to analyze the relationship between the cecal microbiota and fat metabolism. Transferring fecal microbiota from adult chickens with high body weight into one-day-old chickens was examined by oral administration to verify gut microbiota effects on chicken growth through regulation of fat metabolism. There were significant differences in body weight, chest and leg muscle indexes as well as in cross-sectional area of muscle cells, suggesting different growth performance between high and low body weight chickens. By comparing the relative abundance of gut microbes in the cecal content in high and low body weight chickens, we found that Microbacterium and Sphingomonas were more abundant in high body weight chickens and Slackia was more abundant in low body weight chickens. The fat metabolism level was markedly different in serum, liver, abdominal adipose, chest and leg muscles between high and low body weight chickens. Spearman correlation analysis showed a positive correlation between fat metabolism and the relative abundance of Microbacterium and Sphingomonas and a negative correlation between fat metabolism and the abundance of Slackia. Hence, transferring fecal microbiota, instead of saline, from adult chickens with high body weight into one-day-old chickens improved growth performance and fat metabolism in liver. Conclusions These results suggested that cecal microbiota could affect chicken growth performance by regulating fat metabolism.

Direct-acting oral anticoagulant use at extremes of body weight: Literature review and recommendations

Purpose To review the literature on treatment of venous thromboembolism (VTE) and prevention of cardioembolic stroke with direct-acting oral anticoagulants (DOACs) in low- and high-body-weight patients and to make recommendations regarding agent selection and dosing in these patient populations. Summary The selection and optimal dosing of DOACs in low- and high-body-weight patients has not yet been fully elucidated by clinical trials; however, evidence suggests that issues of both safety and efficacy in patients at the extremes of body weight may warrant careful consideration when selecting a DOAC for such patients. This review provides a thorough discussion of the use of DOACs in the treatment of VTE and prevention of cardioembolic stroke in patients at the extremes of body weight and provides guidance regarding agent selection. Conclusion While the published evidence on use of DOACs in patients at extremes of body weight is sparse, apixaban and rivaroxaban appear to have the most favorable safety and efficacy profiles. Edoxaban and dabigatran should be avoided.

Innovative technology and equipment for calves rearing during preweaning period

High dairy performance of adult animals is directly dependent on the conditions of calves growing and feeding during the preweaning period. Since cattle has a low so-called “critical temperature”, it is advisable to use this property of the body when rearing calves in the open air year-round in individual houses. It is known that among the entire complex of factors affecting the intensive growth of calves, the quality of food and the method of calves feeding in the first periods of postembryonic development of young animals from birth to 12 months deserve the most attention. In order to reduce consumption of whole milk for feeding calves and accelerate development of digestive tract in calves in early life period with high body weight gains, in practice specialists try to achieve it by introducing plant foods into diets for calves. However, plant feeds, even high-energy ones (cereals and legumes), containing large amount of protein, carbohydrates, starch, etc., are digested by calves very slowly and in small quantities. It is shown that to eliminate these drawbacks it is advisable to extrude all the plant feeds. The paper describes in detail the technology and equipment for preparing easily digestible feeds based on legumes for calves feeding during preweaning period, allowing to accelerate the development of digestive tract in the early life period of calves with high body weight gains, reduce consumption of whole milk or its replacers and energy costs for its production. Studies on the effect of feeding young cattle with feed concentrate during preweaning period showed increase in performance by 6.6 % and a decrease in feed costs by 5.73 %.